Columbia  SJntomitp 
mtfjeCttpofitagork 

College  of  ipfjpstciansi  ano  burgeons 


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in  2010  with  funding  from 

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A    SV  LL A BUS 


OF    A 


COURSE   OF   LECTURES 


ON    THE 


Diseases   of  the   Nervous   System 

DESIGNED  AS  A  NOTE  BOOK  FOR  THE  USE  OF  STUDENTS 


BY 


HENRY     HUN 

Professor  of  Diseases  of  the  Nervous  System  in  the  Albany  Medical  College 
IN    TWO    VOLUMES 


Vol.    II 

DISEASES    OF    THE    BRAIN 

ILLUSTKATED 


AI.HANY.   N    V 


HP  HIS  SYLLABUS  contains  all  the  didactic  lectures  on  the  diseases  of  the  nervous 
system  delivered  in  the  Albany  Medical  College  on  Monday  mornings  throughout 
a  college  year.  In  the  appendix  is  included  several  lectures  on  the  examination  of 
the  blood  and  excretions,  delivered,  or  rather  demonstrated,  in  the  course  on  clinical 
medicine  on  Wednesday  mornings,  which  lectures,  with  those  published  in  volume  i, 
complete  the  physical  examination  of  patients.  In  the  appendix  is  also  a  syllabus  of 
the  essentials  of  insanity,  which  was  prepared  by  Dr.  Mosher,  and  is  based  upon  his 
course  of  clinical  lectures  on  insanity.  The  sections  on  the  examination  of  the  gastric 
contents  and  of  the  faeces  were  revised  by  Dr.  MacFarlane. 

It  is  intended  that  the  blank  spaces  left  in  the  book  shall  be  filled  by  the  student 
with  notes  taken  at  the  lectures  and  in  his  subsequent  reading. 

I  am  indebted  to  Dr.  George  L.  Streeter  for  the  illustrations  in  this  book. 


COPYRIGHTED   BY 

HKXRY  HUN 
L9C2 


LECTURE  I. 

Diseases  of  the   Brain 

EXAMINATION  OF  PATIENTS 
Introductory 

The  method  of  learning  the  history  of  a  case  and  the  physical  examination  necessary 
to  discover  disturbances  of  motion,  sensation  and  reflex  activity  have  been  described  in 
volume  i  of  this  note-book 


Method  of  testing  disturbances  of:  (i)  consciousness  (coma,  semi-coma,  somnolence),  (2) 
intelligence  (amentia,  dementia,  hallucinations,  delusions,  delirium),  (3)  feelings  (sad, 
joyous,  confused,  apathetic),  (4)  memory  (amnesia) 


Method  of  testing  disturbances  of  vision:    (i)  blindness,  (2)  field  of  vision  for  white  and 
colors,  (3)  hemianopsia,  (4)  psychic  blindness 


Method  of  testing  disturbances  of  speech :    (i)    motor   aphasia,    (2)    sensory    aphasia,    (3) 
transcortical  aphasia 


Method  of  testing :    (i)    agraphia  and   (2)   alexia 


Method  of  testing:    11)   anosmia  and   (2)   ageusia 


Other  tests  not  given  in  volume  one 


LECTURE  II. 
Diseases  of  the   Brain 
DISEASE  OF  THE  CRANIUM  AXD  MEMBRANES 


Introductory 


Cranial  abnormalities 

Developmental:    (i)   acrany,    12)   anencephaly,   (3)  hemicrany,   (4)  enccphalocele.   (5) 
microcephaly,   (6)   brachycephaly,   (7)   dolicocephaly 


1 /' 1    Acquired  from  Disease:    (i)    hydrocephalus   (general,  anterior,  posterior),   (2)   rickets, 
<  j  1  asymetry 


MENINGITIS 

(a)  Pachymeningitis 


(b)  Leptomeningitis 


PACHYMENINGITIS    EXTERNA,    SIMPLE  AND  PURULENT 
Introductory 


Etiology:     (i)  age,  (2)  traumatism,  (3)  extension  of  inflammation   (caries,  otitis,  erysipelas) 


Pathological  anatomy:    (1)    congestion,    (2)  abscess,    (3)   thickening  with  adhesions 


10 


Symptomatology:     (i)  absent,   (2)  masked,  (3)  headache,  (4)  convulsions,  (5)  delirium.  (6) 
coma,  (7)  fever 


Diagnosis 


Prognosis 


Treatment 


Pachymeningitis  Interna  Purulenta 


PACHYMENINGITIS  INTERNA    HAEMORRHAGICA 

(Haematoma  of  Dura  Mater.) 
Introductory 


Etiology:  (i)  age,  (2)  sex,  (3)  infection  (tuberculosis  23$,  syphilis  n#,  puerperal  sepsis  9$), 
(4)  cerebral  disease  19$,  (5)  cardiac  disease  i8#,  (6)  chronic  alcoholism  5$,  (7)  blood 
diseases,  (8)  traumatism 


12 


L3 


Pathological  anatomy 

(a)    Macroscopic:    (i)    appearance  of  membrane,  (2)  position,  (3)  haematoma 


(b)  Microscopic:   (1)  structure,  (2)  inflammatory  or  hemorrhagic  origin 


14 


Symptomatology 

(a)   Previous  to  hemorrhage:  (i)  absent,   {2)   masked,    (3)    uncertain 


(b)  At  the  time  of  and  after  hemorrhage:  (1)  headache,  vertigo  and  vomiting,  (2)  coma, 
(3)  hemiplegia  (complete  or  partial),  (4)  convulsions  and  contractures,  (5)  reflexes 
(pupil,  cutaneous  and  tendon),   (6)   mental  symptoms,  (7)  relapses 


15 


Pathology:    (i)  origin,  (2)  symptoms  caused  by    inflammation,    (3)    symptoms    due    to    hem- 
orrhage,  (4)   transitory  nature  of  symptoms 


16 


Diagonsis 


Prognosis 


Treatment 


LECTURE  III. 
Diseases  of  the  Brain 
DISEASES   OF  THE   MEMBRANES    (Continued) 


ACUTE  LEPTOMENINGITIS 
Introductory 


Varieties:    (i)  cerebro-spinal  (epidemic  form),  (2)  tubercular,  (3)  purulent 


CEREBRO-SPINAL  MENINGITIS 
Introductory     ., 


18 


Etiology:  (i)  age,  (2)  sex,  (3)  epidemics,  (4)  season,  (5)  climate,  (6)  traumatism,  (7) 
cold  and  dampness,  (8)  infection  (Wechselbaum's  diplococcus  intracellulars  meningitidis 
and  Fraenkel's  pneumococcusj 


19 


Pathological  anatomy  :  An  acute  exudative  inflammation  of  the  pia  mater  of  the  brain  and 
spinal  cord  and  of  the  nerve  sheaths:  (i)  hyperaemia,  (2)  hemorrhages,  (3)  exudation 
(serum,  fibrin,  pus),  (4)  dilated  ventricles,  (5)   neuritis 


Symptomatology 

(a)   Incubation 


(b)  Prodromal 


20 


(c)    Meningeal   irritation:    (i)    sensory,    (2)  motor,  (3)  psychic 


21 


(d)  Paralytic  symptoms:  (i)  sensory,  (2)   motor,  (3)  psychic 


O)  Cutaneous  lesions:   (1)  herpes,   (2)  petechiae,   (3)   taches  cerebrales,   (4)   corneal  and 
conjunctival   inflammations 


22 


(/)  Reflexes:  (i)  pupil,  (2)  tendon,  (3)  cutaneous,     (4)    organic,     (5)    respiratory,     (6) 
Kernig's 


(g)   Constitutional  symptoms:  (1)  temperature,  (2)  pulse,  (3)  emaciation,  (4)  constipation, 
(5)  albuminuria,  (6)  glycosuria 


23 


(h)   Lumbar  puncture:  (i)  tension  of  cerebro-spinal  fluid,  (2)  character  of  fluid,  (3)  bacte- 
rial content 


(t)   Sequelae:  (1)  headache,  (2)  blindness,   (3)   deafness,   (4)   aphasia,   (5)  paralysis,   (6) 
convulsions,  (7)  mental  weakness 


24 


Pathology,    (i)  origin,  (,)  cause  of  irritative  symptoms,  (3)  cause  of  parahtic  svmptoms,  (4) 
symptoms  due  to  mvolvment  of  peripheral  nerves,  I  5  ,  cause  of  sequelae  ' 


Diagnosis 


Differential  diagnosis 
(a)   From  typhoid 


(b)   From  tetanus 


(c)   From  uraemia  and  diabetes 


(d)   From  sinus  thrombosis 


(e)   From  alcoholic  and  other  deliriums 


(f)   From  pachymeningitis 


(g)   From  cerebral  abscess 


(h)   From  septicaemia 


26 


Prognosis    and    course:      (i)    great   variations,    (2)    abortive    form.    (3)    fulminating    form, 
(4)   average  mortality 


Treatment:     (1)   prophylactic,   (2)   rest  in  dark,   (3)   cold  to  head  and  warmth  to  extremities, 
(3)  blisters,  (4*)  drugs  (morphine,  mercury,  etc.).  (£)  lumbar  puncture 


27 


LECTURE  IV. 

Diseases  of  the   Brain 

DISEASES  OF  THE  MEMBRANES  (Continued) 


TUBERCULAR  MENINGITIS 
Introductory 


Etiology:     (i)  age,  (2)  traumatism,  (3)  bacillus  tuberculosis 


•is 


Pathological  anatomy:     (i)   exudation,   (2)  thickening  of  pia   mater,    (3)    miliary   tubercles, 
(4)   dilated  ventricles,  (5)  hydrocephalus 


Symptomatology:     (i)  absent,  (2)  masked 
(a)   Those  of  original  disease 


(b)   Prodomata:    (1)    peevishness,    (2)    anorexia,  (3)  emaciation,  (4)  mental  dulness 


(c)   Meningeal  irritation:    (1)   sensory,   (2)   motor,   (3)  psychic,   (4)  hydrocephalic  cry 


30 


(d)   Hydrocephalus 


I  e  I    <  >phtalmoscopic  changes:  (i)  choked  disc,  (2)  tubercles  in  choroid 


I  f  )    Lumbar  puncture 


( g)   Other  symptoms  are  in  the  main  quite  similar  to  those  of  epidemic  cerebro-spinal  menin- 
gitis, but  are  usually  less  intense 


::l 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment 


S2 


PURULEXT  MENINGITIS 
Introductory 


Etiology:     (i)  traumatism,   (2)  extension  of  inflammation     (otitis,    caries,    sinus    thrombosis, 
erysipelas,  carbuncle,  etc.),   (3)  infection  (septicaemia,  small-pox,  etc.),  (4)  insolation 


Pathological   anatomy:     (i)   congestion,   (2)  exudation    (pus),   (3)   abscess,    (4)    extent,    (5) 
bacteria 


Symptomatology:     (1)  absent,  (2)  masked 


(a)   Those  of  original  disease 


(b)   Prodromal 


(c)   Same  as  in  epidemic  form  with  minor  exceptions 


34 


Pathology 


Diagnosis 


Differential  diagnosis 

(a)   Cerebro-spinal  meningitis:   (i)   epidemic,  (2)  primary  disease,  (3)  lumbar  puncture 


(b)   Tubercular  meningitis:  (1 )  primary  disease,  (2)  lumbar  puncture 


(c)   Purulent  meningitis:  (1)  primary  disease,  (2)  lumbar  puncture 


Prognosis  and  course 


Treatment 


SEROUS  AND  OTHER  FORMS    OF    ACUTE    MENINGITIS 


36 


LECTURE  V. 

Diseases  of  the  Brain 

DISEASES  OF  THE   MEMBRANES    (Concluded) 


CHRONIC  LEPTOMENINGITIS 
Introductory 


Etiology,     i  Excluding  syphilis  and  tuberculosis):  (i)  alcohol,  (2)  insanity,  (3)  age 


Pathological  anatomy ;     (i)    color,    (2)    thickening,    (3)    structure,    (4)    vascular    occlusion, 
(5)  hydrocephalus 


Symptomatology:  (1)  absent,  (2)  headache,  vertigo,  vomiting,  (3)  tenderness,  (4)  delirium 
and  mental  dulness,  (5)  insanity,  (6)  localized  spasms,  (7)  localized  paralyses,  (8)  rigidity 
of  extremities,  (9)  strabismus,  nystagmus  and  optic  neuritis 


:;,s 


Pathology:    (i)   congestion  and  irregular  blood  supply 


Diagnosis:     (i)  difficult  and  uncertain,  (2)  primary  disease  or  injury 


Prognosis  and  course 


Treatment:      (1)    blisters,    (2)    drugs    (mercury,  iodides) 


40 


ACUTE  HYDROCEPHALUS 


CHRONIC  EXTERNAL  HYDROCEPHALUS 


ii 


CHRONIC    INTERNAL  HYDROCEPHALUS 
Introductory 


Etiology 

(a)    Congenital:    (i)    heredity,    (2)    syphilis  in  parents,  (2)  alcoholism  in  parents 


(b)   Acquired:  (1)  rarer  than  congenital,  (2)   meningitis 


42 


Pathological  anatomy 

(a)   Congenital:   (i)  bones  and  sutures,   (2)  membranes  of  brain  and  choroid  plexuses,  (3) 
ventricles,  (4)  brain  tissue,  (5)  miscroscopic  appearance,  (6)  character  of  effusion 


(b)   Acquired 


Symptomatology:  (i)  enlargement  of  head,  (2)  sutures  and  fontanelles,  (3)  small  face,  (4) 
idiocy,  imbecility  or  feeble-minded,  (5)  headache  and  vomiting,  (6)  convulsions,  (7)  par- 
alyses, (8)  rigidity,   (9)   reflexes,  (10)  optic  neuritis,  (11)  lumbar  puncture 


44 


Pathology 


Diagnosis:    (i)  enlarged  head,  (2)  defective  intelligence 


Differential  diagnosis 
(a)   From  rickets 


(b)   From  cerebral  tumor 


Prognosis  and  course 


Treatment 


46 


LECTURE  VI. 

Diseases  of  the   Brain 

INJURY 
Introductory 


CONCUSSION  OF  THE  BRAIN 
Introductory 


Etiology:     (  i)  blow  over  large  area  of  skull,  (2)  individuality,  (3)  drunkard 


Pathological  anatomy 

(a)   Many  sources  of  error 


(b)   In  mild  cases 


(c)   In  fatal  cases:  (i)  microscopic  changes  in  nerve  elements,   (2)  vascular  changes,   (3) 
contusions,  (4)  hemorrhages 


(d)   Secondary  or  remote  changes:   (1)  meningitis,  (2)  tumor,  (3)  sclerosis 


48 


Symptomatology 

(a)   Mental  confusion,  etc.,  occurs  immediately  and  is  very  transitory 


(b)   Mild  cases:   (i)   bewildered,   (2)  nausea,  (3)  sweat,  (4)  tremor,  (5)  delirium 


(c)   Severe  cases:  (1)  coma  or  semi-coma,  (2)     vomiting,     (3)     vascular     and     respiratory 
■changes,  (4)  temperature,  (5)  pupils,  (6)  delirium,  (7)  shock 


i" 


(d)   Great  variation  in  intensity  and  duration  of  symptoms 


(c)   Remote  symptoms  of:  (i)  meningitis,    (2)  insanity,  (3)  tumor,  (4)  sclerosis 


n 


50 


Pathology:    (i)  shaking- of  brain,  (2)  shock,  (3)    inhibition,    (4)    movement   of   cerebro-spinal 
fluid,   (5)  pressure 


51 


Diagnosis 


Prognosis    and    course:      (i)  guarded,   (2)  depends  on  severity  and  duration  of  symptoms 


Treatment:     (1)    cold  to  head,   (2)   warmth  to  extremities,  (3)  purgatives,  (4)  stimulants 


52 


COMPRESSION  OF  THE  BRAIN 
Introductory 


Etiology:     in   injury,   (2)   depressed  bone,   (3)   hemorrhage 


Pathological  anatomy  :      (1)  that  of  primary  disease,   (2)  compression  of  brain,   (3)   cerebral 
veins  empty,  arteries  congested 


Symptomatology 

(a)   May  not  occur  immediately 


(b)  Those  of  concussion  may  precede  and  accompany  those  of  compression 


(c)   General  not  local 


(d)  Symptoms  of  irritation:  (i)  congested  face,   (2)   contracted  pupil,   (3)  headache,   (4) 
vomiting,  (5)  slow  pulse 


(e)   Symptoms  of  depression:   (1)   coma,   (2)  pupils  dilated,  (3)  pulse  and  respiration,  (4) 
paralyses 


54 


Pathology:    (i)  increased  uniform  pressure,  (2)   irritation  and  inhibition 


Diagnosis:    (1)  nature  of  injury,  (2)  escape  of  blood  or  fluid  from  ears.    (3)    delayed  symp- 
toms,   (4)   severity  and  duration  of  symptoms 


Prognosis    and    course:     (1)    intensity  and  progressive  nature  of   symptoms,    (2)    possibility 
of  operation 


Treatment  :    (1)  remove  cause  by  trephining,  1  2  1   purgation 


LECTURE  VII. 
INJURY  (Concluded) 


CONTUSION  OF  THE  BRAIN 
Introductory 


Etiology 


Pathological  anatomy 

(a)   Hemorrhage  and  laceration  of  cerebral  cortex  at  point  of  injury  or  at  point  of  brain 
directly  opposite  (contre  coup),  or  at  both 


(b)   Clustered  or  widely  disseminated  minute  extravasations  of  blood 


56 


Symptomatology 

(a)   General:  (i)     shock  or  coma,  (2)  pulse.  (3)  temperature,  (4)  pupils 


(b)   Local:   (1)   often  absent,   (2)   spasm  or  contracture,  (3)  paralyses 


Pathology 

(a)  General  symptoms  are  a  mixture  of  those  of  concussion  and  compression 


(b)   Local  symptoms  depend  on  cortical  centers  injured 


Diagnosis 


Prognosis  and  course 


Treatment 


58 


PENETRATING  WOUNDS  OF  THE  BRAIN 
Introductory 


Etiology  :     (i)  stabs,   (  _>  )  gun-shot  wounds 


Pathological   anatomy:     (i)    division  of  tissue.  (2)  hemorrhage,  (3)  laceration  and  infection, 
(4)  sloughing,  (  5  )  suppuration 


Symptomatology 

(a)   ( ieneral :   I  1  )   shock  or  coma 


(/m    Local:  (1)  irritative,  (2)  destructive 


(c)   Great  variations  according  to  locality 


(d)   Foreign  bodies  remaining  in  brain  often  after  years  lead  to  suppuration 


Pathology 


Diagnosis 


Prognosis  and  course 


60 


Treatment  :     (i)  trephine,  (2)  disinfect,  (3)  close  wound,  (4;  remove  foreign  body  when  pos- 
sible, (5)  danger  of  probing 


MENINGEAL  HEMORRHAGE 
Introductory 


Etiology:     (1)  injury,  (2)  aneurism,  (3)  pachymeningitis 


Pathological   anatomy:    (1)   position,   (2)   extent,    (3)    appearance,    (4)    changes,    (5)    cyst, 
(6)  brain  compression  and  anaemia 


61 


Symptomatology 

(a)   Absent  or  latent 


(b)  General:  (i)  coma,  (2)  pulse  and  respiration,    (3)    pupils,    (4)    remission 


(c)   Local:  (1)  varying  with  seat  of  lesion,   (2)   irritation,   (3)  paralytic,   (4)  temporary 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment 


62 


LECTURE  VIII. 

Diseases  of  the  Brain 

CIRCULATORY  DISEASES  OF  THE  BRAIN 
Introductory 


CEREBRAL  ANAEMIA 

Etiology:     (i)   general  anaemia,   (2)   cardiac  inadequacy,  (3)  emotions  and  vaso-motor  spasm, 
(4)  atheromatous  arteries 


Pathological  anatomy 

(a)   Conditions  after  death  may  differ  from  those  during  life  and  may  vary  with  the  manner 
of  making  the  autopsy 


(b)   Microscopic  changes:   (i)  color,  (2)  punctae    vasculosae,     (3)     atheromatous    arteries, 
(4)   softening 


(c)   Microscopic  changes 


Symptomatology 

(a)  Functional  anaemias :  (1)  fainting,  (2)  vertigo,    (3)    tinnitus   aurium,    (4)    dimness   oi 
vision,    (5)   nausea,    (6)    feebleness,   (7)  drowsiness,  (8)  convulsions 


64 


(b)   Cerebral   anaemia  due  to  atheromatous  arteries 


Pathology 


Diagnosis 

( a  )   All   other   conditions   must   be   excluded 


( b  )    General  anaemia,  cardiac  inadequacy,  atheromatous   arteries    or   emotional    disturbances 
must  be  present 


Prognosis  and  course 


Treatment:     (i)   remove  the  cause,   (2)   posture,  (3)  blood  tonics,  (4)  cardiac  tonics,  (5)  vas- 
cular dilators,  (6)  nervines 


i;<) 


CEREBRAL  HYPERAEMIA 

Etiology 

(a)    Active:  (i)  worry  and  emotions.  (2)  vase-motor  paralysis,  (31  excessive  cardiac  action 


( 7' I    Passive:  (1)  venous  obstruction 


Pathological  anatomy 

(a)   Condition   of  blood  vessels  may  change  after  death  and  depend  <»n  manner  of  making 
autopsy 


(b)   Macroscopic  appearances :  (1)  color,  (2)    engorged    vessels,    (3)    punctae    vasculosae, 
(  4 )   oedema 


Symptomatology     (fanciful):   (i)   headache,    (2)   fulness,  (3)  mania  and  delirium,   (4)  apo- 
plectiform attacks 


Pathology:     (1)  pressure,  (2)  hyperactivity  from  excessive  blood  supply 


Diagnosis 

(a)   All  other  conditions   must  be  excluded 


(b)   Possible  etiological  factors  must  be  present 


Prognosis  and  course 


Treatment:     (1)  remove  the  cause,  (2)  posture,  (3)  purgatives,  (4)  diuretics,  (5)  diaphoret- 
ics,   (6)    drugs    (ergot,   belladonna,   bromide,  morphine) 


CEREBRAL  OEDEMA 
Etiology:   (always  a  secondary  disease) 

(a)   General:   (i)   nephritis,   (2)   general  venous  obstruction 


(b)   Local:   (1)   local  venous  obstruction,  (2)  inflammation,  (3)  tumors 


Pathological  anatomy:    (1)   color,   (2)   moisture,  (3)  punctae  vasculosae 


Symptomatology:     (1)   coma,    (2)   convulsions    (local   or   general),    (3)    paralyses    (local   or 
general ) 


69 


Pathology:    (i)    pressure,    (2)    loss   of   function  from  interference  with  blood  supply 


Diagnosis 


Prognosis  and  course 


Treatment:    (1)    posture,    (2)    purgatives,    (3)  diuretics,  (4)  diaphoretics,  (5)  drugs  (glonoin, 
digitalis) 


LECTURE  IX. 

Diseases  of  the   Brain 

CIRCULATORY  CEREBRAL     DISEASES    (Continued) 

APOPLEXY 

Introductory 


CEREBRAL  HEM(  >RRHAGE 

Etiology 

km   Predisposition:    (i)    heredity,    (2)    age,  (3)  sex 


71 


(&)   Traumatism:  (i)  blows,  (2)  birth 


(c)   Haemic  diseases:  (1)  scurvy,  (2)  purpura,  (3)  pernicious  anaemia,  (4)  leucocythaemia 


(d)   Arterial    degeneration:    (1)    miliary    aneurism,    (2)    peculiar    to    brain,     (3)    peculiar 
character  of  cerebral  arterioles,   (4)  relationship  to  atheroma,  (5)  dissecting  aneurisms 


72 


(e)   Causes  of  arterial  degeneration :  (i)  syphilis,   (2)  nephritis,   (3)  alcoholism,   (4)   rheu- 
matism and  gout,  (5)  lead,  (6)  chronic  congestion  (worry) 


(f)  Increased  blood  tension :  (i)  doubtful  cause,  (2)  posture 


71 


Pathological  anatomy 

(a)   Location  in  the  order  of  relative  frequency :    (i)    corpus   striatum,   optic  thalamus   and 
internal  capsule,  (2)  centrum  ovale,  (3)  cortex,  (4)  peduncle,  (5)  pons,  (6)  cerebellum 


(b)  Arteries  affected:   (1)   lenticulo-striate,  (2)  lenticulo-optic,   (3)   anterior  corpus  striate, 
(4)  choroid 


(c)   Appearance:  (1)  size  and  shape,  (2)  coagulum,  (3)  red  softening,  (4)  compression  of 
nerve  tissue,  (5)  destruction  of  nerve  tissue,  (6)  effusion  into  ventricles 


75 


(d)  Alteration  in  appearance  with  time:  (i)  color,  (2)  degeneration,  (3)  liquefaction,  (4) 
absorption,  (5)  cyst,  (6)  scar,  (7)  secondary  degeneration 


76 


:: 


Symptomatology 

(a)  Prodromal:  (i)  uncertain  and  uncommon,  (2)  headache,  (3)  vertigo,  (4)  tinnitus 
aurium,  (5)  irritability,  (6)  disordered  mental  action,  (7)  drowsiness,  (8)  local  par- 
alyses,  (9)  paraesthesiae,   (10)   epistaxis 


(&)   Cardinal  symptoms:  (1)  sudden  onset,  (2)  general  shock,  (3)  local  paralysis 


78 


(c)   Onset:  (i)  from  one  second  to  24  hours,  (2)  death,  (3)  coma,  (4)  headache,  vertigo, 
confusion  and  vomiting,  (5)  paralysis,  (6)  convulsions 


(d)   General  shock  or  acute  stage:  (i)  coma  or  semi-coma,  (2)  temperature,  (3)  pulse,  (4) 
respiration,   (5)  pupils,   (6)  eye-balls  and  head,  (7)  motion,  (8)  sensation,  (9)  reflexes 


80 


(e)  Local  paralysis  or  chronic  stage:  (i)  absent,  (2)  distribution  (hemiplegia,  hemianopsia, 
aphasia,  etc.),  (3)  temporary  and  permanent,  (4)  order  of  recovery  (face,  leg,  arm), 
(5)  reflexes,  (6)  automatic  movements,  (7)  mental  weakness,  (8)  residual  motor  dis- 
turbances (contractures,  tremor,  chorea,  athetosis,  spasms,  atrophy),  (9)  bed  sores 


82 


LECTURE  X. 

Diseases  of  the   Brain 

CIRCULATORY  CEREBRAL     DISEASES    (Continued) 

CEREBRAL  HEMORRHAGE   (Continued) 
Pathology 

(a)   Prodromata  due  to  atheromatous  arteries 


(b)   Coma  due  to  the  hemorrhage:   (i)  suddenly  increased  pressure,    (2)   local  and  general 
anaemia,  (3)  oedema  of  brain,  (4)  tearing  of  nerve  tissue 


84 


(c)   Temperature,   pulse   and   respiration   disturbed  by  irritation  or  paralysis  of  correspond- 
ing centers  in  brain 


(</)    Reflexes  abolished  on  account  of  irritation  of  descending  tracts 


(e)   Local  paralysis  varies  with  location  of  hemorrhage  and  is  temporary   (pressure)   or  per- 
manent (destructive) 


(/)   Order  of  recovery 


(g)   Contracture  and  other  motor  disturbances 


86 


Diagnosis 


Differential  diagnosis  of  coma 
|  a  i   Fainting 


(b)   Uraemia 


(c)   Diabetes 


B7 


(d)   [Morphine  poisoninj 


(e)   Alcoholic  poisoning 


(/)   Illuminating  and  coal  gas  poisoning 


(g)   Internal  hemorrhage 


(h)  Apoplectiform  attacks  in  brain  disease  (paresis,  tumor,  cerebral  palsy) 


(i)   Epilepsy 


(/)   Hysteria 


(k)    Sunstroke 


Prognosis  and  course:  (  I  )  always  serious,  (2)  time  of  death.  131  temperature.  (4)  duration 
and  manner  of  onset  of  coma.  (5)  respiration,  (6)  rapidity  of  improvement,  171  contract- 
us second  and  third  attacks 


90 


Treatment 

(a)   Prophylaxis:   (i)   excesses   (alcohol  and  venery),  (2)  worry,  (3)  rheumatism  and  syph- 
ilis, (4)  drugs  (iodides  and  glonoin) 


(b)   The  attack:  (1)  rest  and  posture,  (2)  cold  to  head,  warmth  to  extremities,  (3)  bleeding, 
(4)  purgation,  (5)  drugs  (glonoin,  ergot,  morphine,  bromides) 


mi 


(c)   The  paralysis:    (i)   exercise,    (2)   electricity,    (3)    massage,    (4)    Sweedish  movements, 
(  5  )   strychnine.   (6)  hydrotherapeutics 


92 


LECTURE  XI. 

Diseases  of  the   Brain 

CIRCULATORY  CEREBRAL    DISEASES    (Concluded) 

ACUTE  SOFTENING 
Introductory 


CEREBRAL  EMBOLISM  AND  THROMBOSIS 
Etiology 

(a)   Embolism:  (i)  age,  (2)  sex,  (3)  origin  of  embolus   (endocarditis,  endarteritis,  aneur- 
ism, thrombi  in  beart  or  lungs) 


(b)   Thrombosis:  (i)  age,  (2)  sex,  (3)  arterial    degeneration,     (4)    haemic    changes,     (5) 
cardiac  weakness 


94 


Pathological  anatomy:  (i)  similarity  of  lesions  in  embolism  and  thrombosis,  (2)  occluded 
vessel,  (3)  situation,  (4)  red,  yellow  and  white  softening,  (5)  cyst  formation,  (6)  primary 
lesion 


Mf 


96 


Symptomatology 

(a)  Of  the  primary  disease 


(b)   Of  the  prodromata 


|  c  |   Of  the  attack  and  acute  stage 


( d )   <  >f  the  local  paralysis  and  chronic  stage 


Pathology 


Diagnosis 


Differential  diagnosis 

(a)   From  embolism 


(b)   From  thrombosis 


(c)   From  hemorrhage 


Prognosis  and  course 


Treatment 

(a)   Prophylactic 


(b)   Of  the  attack  and  paralysis 


98 


SINUS  THROMBOSIS 
Introductory 


Etiology:     (i)  infection  (caries  and  otitis),  (2)    infectious    diseases    (especially    of    head    and 
neck),  (3)  terminal  infection  (marantic),   (4)  sluggish  circulation,  (5)  chlorosis,  (6)  age 


100 


Pathological  anatomy:     (i)    thrombosis,    (2)   color,  (3)  oedema,  (4)  hemorrhage,  (5)  abscess 


Symptomatology 

(a)   General:   (1)   very  varied,   (2)   primary  disease,  (3)  chill,  (4)  psychic,  (5)  spasm  and 
convulsions,  (6)  pain,  (7)  fever 


KM 


(&)  Special:  (i)  Superior  longitudinal  sinus  (epistaxis,  oedema  of  forehead),  (2)  trans- 
verse sinus  (oedema  behind  ear,  jugular  veins),  (3)  cavernous  sinus  (oedema  of  con- 
junctiva, prominence  of  eyeball,  oedema  of  temple) 


102 


Pathology:    (i)  local  oedema,  (2)  abscess 


Diagnosis  :   (1)  cause  for  thrombosis,  (2)  symptoms  of  meningitis  of  mild  intensity  and  without 
retraction  of  head,  (3)  external  oedema,  (4)  tenderness  over  jugular 


Prognosis  and  course 


Treatment 


[08 


LECTURE  XII. 
Diseases  of  the  Brain 
CEREBRAL  PALSY  OF  CHILDHOOD   (PORENCEPHALY) 


Introductory 


Etiology:     (i)  age,  (2)  sex,  (3)  heredity,  prenatal  influences  and  injury  at  birth,   (4)   injury 
in  infancy,  (5)  infection,  (6)  syphilis 


104 


Pathological  anatomy :     (i)  porencephaly.   (2)    secondary    degeneration,    (3)    developmental, 
(4)  hemorrhage,  (5)  vascular  occlusion,  (6;  inflammation.  (7)  sclerosis 


lu:> 


Symptomatology 

(a^  Hemiplegia:  (i)  paralysis,  (2)  convulsions,  (3)  coma,  (4)  fever,  etc.,  (5)  contracture, 
rigidity  and  increased  reflexes,  (6)  atrophy,  arrest  of  development  and  deformities,  (7) 
posthemiplegic  motor  disorders,  (8)  epilepsy,  (9)  psychic 


106 


107 


(b)    Diplegia:    (i)    double  hemiplegia,  complete  or  partial,  (2)  same  as  in  hemiplegic  form 
but  bilateral 


Pathology:    ( 1 )  in  general  similar  to  that  of  meningeal   hemorrhage,    (2)    paralytic   symptoms, 
(3)   irritative  symptoms,   (4)   psychic  symptoms,  (5)  atrophy  and  deformities 


108 


Diagnosis 


Differential  diagnosis 

(a)    From  poliomyelitis  anterior  acuta:  (i)  reflexes,   (2)   electrical  reaction  of  degeneration 


1 /- 1    From  multiple  sclerosis:  (  1  1  chronic  progressive  course,  (2)  speech,  (3)  electrical  reac- 
tion of  degeneration 


iw 


(c)   From  Friedrich's  Ataxia:  (i)  tendon  reflexes,   (2)   spastic  symptoms,   (3)   ataxia 


Prognosis  and  course 


Treatment:     (1)    electricity,    (2)    massage,    (3)    tenotomy,    (4)    orthopaedic    apparatus,     (5) 
drugs 


110 


LECTURE  XIII. 

Diseases  of  the  Brain 

INFLAMMATION 

ENCEPHALITIS 
Introductory 


Varieties:  (i)  polioencephalitis  acuta  hemorrhagica  superior  (Wernicke),  (2)  acute  encepha- 
litis of  children  and  adults  (Struempell),  (3)  meningoencephalitis,  (4)  reactive  inflam- 
mations, (5)  abscess 


111 


CEREBRAL  ABSCESS 
Introductory- 


Etiology  :  (i)  age,  (2)  sex,  (3)  infection  (injury  20-24$,  caries  50$,  infected  thrombosis), 
(4)  infectious  diseases  (meningitis,  typhoid,  scarletina,  influenza,  erysipelas,  pyaemia, 
tuberculosis,  actinomycosis) 


112 


Pathological  anatomy:     (i)    location    (cerebral  hemispheres  jii,  cerebellum  25',.  both  cerebral 
hemispheres  and  cerebellum  2<£,  brain  stem  \ri),  (2)  number,   (3)   size.   141  capsule,   (5)   pus 


118 


Symptomatology 

(a)   Of  primary  disease 


(b)   General:  (i)   fever,  (2)  headache,  vertigo  and  vomiting,  (3)  convulsions,  (4)  psychic, 
(5)  optic  neuritis,  (6)  pulse  and  respiration,  (7)  latent  stage 


114 


(c)  Local 


(d)   Complications:  (i)  rupture,  (2)  meningitis 


115 


Pathology:    (i)    increased  pressure,   (2)   irritation,  (3)  inhibition,  (4)  destruction 


Diagnosis  :    (1)  etiology,  (2)  latent  stage 


116 


Differential    diagnosis 

(a)    From  meningitis:   (i)   intensity  and  acuteness  of  symptoms,    (2)    fever,   (3)   retraction 
of  head,  (4)  optic  neuritis.  (5)  pronounced  psychic  symptoms.  (6)  Kernig's  symptom 


(b)    From  cerebral  hemorrhage:   (i)   immediate  result  of  injury,  121  no  infection.  (3)  sud- 
denness of  onset,  (4)  headache 


(c)    Sinus  thrombosis:   (1)  marantic  condition.    (2)    moderate   intensity   of   symptoms.    13) 
fever,  (4)  external  oedema,  (51  rarely  local  symptoms 


1  (/ 1   1  lerebral  tumor 


117 


Prognosis  and  course 


Treatment:     (i)  prophylactic,   (2)  evacuation  and  drainage,  (3)  same  as  meningitis 


118 


LECTURE  XIV. 

Diseases  of  the  Brain 

INTRACRANIAL  TUMOR. 
Introductory 


Etiology:     (i)  age,   (2)  sex,   (3)  heredity,   (4)  congenital  defect,   (5)  infection  and  parasites 
(syphilis,  tubercle,  etc.),  (6)  metastatic,  (7)  injury 


119 


Pathological  anatomy:  (i)  location,  (2)  varieties  (glioma,  psamoma,  sarcoma,  carcinoma, 
tubercles,  gumma,  lipoma,  myxoma,  chloesteatoma,  aneurism,  cyst),  (3)  relative  frequency, 
excluding  gummata,  which  are  most  frequent,  (tubercle  53^,  glioma  15&  sarcoma  15&  others 
17$),  (4)  differentiation  from  brain  tissue,  (5)  changes  in  brain 


120 


121 


Symptomatology 
(a)  Absent 


(b)   General:  (i)  headache,  (2)  vertigo  and  vomiting,   (3)   choked  disc  and  optic  neuritis, 
(4)  psychic  symptoms,  (5)  convulsions,  (6)  pulse  and  respiration 


122 


(c)  Local 


Pathology:    (i)   increased  pressure,   (2)   irritation,  (3)  inhibition,  (4)  destruction 


Diagnosis:     (1)  steady  increase  of  severe  psychic,  motor  and  sensory  symptoms,   (2)   headache, 
(3)   choked  disc,   (4)  local  symptoms 


121 


Differential  diagnosis 

(a)    From  meningitis:  (i)   fever,   (2)   retraction  of  head.  (3)  lumbar  puncture 


(b)   From  abscess  (1)  etiology.  (2)  acute  course,  (3)  latent  si 


125 


(c)   From  general  paresis:  (i)  speech  and  tremor,  (2)  exaltation.  (3)  choked  disc 


(d)   From  epilepsy:  (1)  convulsion  only  symptom,  (2)  no  choked  disc 


(e)   From  hysteria:  (1)  hysterical  stigmata 


(/)   Atheromatous   arteries    with    local    softenings:      (1)   multiplicity  of  symptoms,    (2)   no 
choked  disc 


(g)   From  internal  hydrocephalus:    (1)   slow    course,    (2)    multiplicity    of    symptoms,    (3) 
deformity  of  skull 


126 


Prognosis  and  course 


Treatment  :     (i)    palliative,    (2)    medicinal,    (3)   surgical 


LECTURE  XV. 
Diseases  of  the  Brain 
SYPHILIS  OF  THE  NERVOUS  SYSTEM 
Introductory:     (i)  in  general,  (2)  post  syphilitic  nervous  diseases,   (3)  tertiary  nervous  syph- 
ilis, (4)  secondary  nervous  syphilis 


128 


Etiology:     I'd   age.   (2)   sex,   (3)   heredity,   (4)     syphilitic     germ     or     toxine.     congenital     or 
acquired,   (5)   interval  between  infection  and  nervous  symptoms,   (6)   predisposing  can 


129 


Pathological  anatomy 

(a)  Of  gumma:  (i)  appearance,  (2)  structure 


(b)  Of  meningitis  gummosa 


130 


(c)   Of  arteritis  syphilitica:   (i)   periarteritis    gummosa,    (2)    endarteritis    syphilitica,    (3) 
local  softening 


(d)   Of  perineuritis  syphilitica 


(e)   A  combination  of  the  above  described  lesions 


(f)   Syphilitic  inflammations  are  rare  and  1111  rertain 


131 


Symptomatology 

(a)    In  general:    (i)   multiple,  multiform  and   variable,    (2)    paretic   rather  than   paralytic, 
(3)  nocturnal  headache 


(b)  Of  meningitis  gummosa  cerebralis :  (1)  headache  (nocturnal),  (2)  vertigo  and  vomit- 
ing, (3)  insomnia,  (4)  psychic,  (5)  convulsions,  (6)  polyuria,  (7)  implication  of  cra- 
nial nerves  (meningitis  basilaris),  (8)   cortical  symptoms  (meningitis  corticalis) 


132 


LECTURE  XVI. 
Diseases  of  the   Brain 

SYPHILIS   OF  THE   NERVOUS   SYSTEM   (Concluded) 

Symptomatology  (concluded) 

(c)  Of  cerebro-spinal  syphilis  (cerebro-spinal  syphilitic  meningitis):  (i)  same  symptoms 
as  described  under  "  b"  but  less  intense,  (2)  sensory  spinal  symptoms,  (3)  motor  spinal 
symptoms 


134 


(d)   Of  arteritis  syphilitica:   (i)   cerebral  or  spinal  anaemia,  general  or  local,   (2)   cerebral 
or  spinal  thrombosis,  (3)  bulbar  symptoms 


(e)   Of  perineuritis   syphilitica:    (i)    usually   associated   with   meningitis,    (2)    optic   nerve, 
(3)  oculo-motor  nerve,  (4)  other  cranial  nerves,  (5)  spinal  nerves,  (6)  multiple  neuritis 


136 


(/)  Of  isolated  gumma 


Pathology 


187 


Diagnosis:  (i)  history  of  infection  or  previous  syphilitic  symptoms,  (2)  nocturnal  headache, 
(3)  optic  neuritis,  ptosis,  Argylle-Robertson  pupil,  (4)  multiplicity,  variability,  incomplete- 
ness and  transitory  nature  of  symptoms 


138 


Differential  diagnosis  of  the  different  forms 


Prognosis    and    course:     (i)   bad  unless  treated,    (2)    curability,    (3)    hereditary    form,    (4) 
arteritis,  (5)  meningitis,  (6)  neuritis,  (7)  effect  of  tuberculosis  and  alcoholism,   (8)   course 


Treatment:     (i)    prophylactic,    (2)    drugs,    (3)  duration  of  treatment 


140 


LECTURE  XVII. 
Diseases  of  the  Brain 
CEREBRAL  LOCALISATION 
Introductory 


141 


(a)  Localisation  within  the  motor  area:  (i)  extent  of  motor  area,  (2)  leg,  (3)  arm,  (4) 
face,  (5)  minute  representation,  (6)  multiple  representation,  (7)  centers  of  innervation 
feelings,  (8)  sensory  disturbances,  (9)  involvment  by  lesion  of  projection  and  associa- 
tion fibres,  (10)  irritative  symptoms,  (11)  inhibitory  symptoms,  (12)  paralytic  symp- 
toms,  (13)  diagnostic  points,   (14)  restitution 


142 


143 


144 


146 


(b)  Localisation  within  the  parietal  lobe:  (i)  no  local  symptoms,  (2)  may  involve  motor 
centers,  (3)  muscle  sense,  (4)  conjugate  deviation  of  eyeballs,  (5)  hemianopsia,  (6) 
alexia 


146 


1 1: 


(c)  Localisation  within  the  occipital  lobe :( i )  no  local  symptoms,  (2)  hemianopsia,  (3) 
hemiamblyopia  and  hemichromatopsia.  (4)  psychic  blindness,  (5)  optic  aphasia,  (6) 
alexia,  (7)  visual  hallucinations 


14S 


141) 


150 


CEREBRAL   LOCALIZATION. 


Fig.  i.  The  Lateral  Surface  of  the  Left  Hemisphere  showing  the  situation  of 
the  Cortical  Centers.  The  principal  motor  area  is  dotted  in  black.  The 
cutaneous  and  muscular  sensory  area  is  dotted  in  red,  overlapping  the  motor 
area. 


TACIAL  \       ARM 

HYPOGLOSSAL 

Fig.  2.     Horizontal  Section  through  Right  Hemisphere  showing,    in    red,    the 

principal     tracts    situated    in    the    Internal    Capsule.        Kn,     Genu    of    Corpus 
Callosum;     F,     Fornix;      NC,     Caudate      Nucleus:     XL,      Lenticular      Nucleus; 

OT,    Optic    Thalamus:    Sp,    Splenium   of   Corpus   Callosum, 


LECTURE  XVIII. 

Diseases  of  the  Brain 

CEREBRAL  LOCALISATION    (Concluded) 

(d)   Localisation  within  the  frontal  lobe:   (i)  no  local  symptoms,  (2)  psychic,  (3)  cerebellar 
ataxia.   (4)   anosmia  and  amblyopia  (5)  trunk  muscles,  (6)  agraphia,  (7)  motor  aphasia 


161 


152 


(e)  Localisation  within  the  temporal  lobe:  (i)  no  local  symptoms,  (2)  sensory  aphasia,  (3) 
anosmia,    (4)    auditory  and  odoriferous  hallucinations 


154 


(f)   Localisation  within  the  central  white  substance 


(g)  Localisation  within  the  internal  capsule :  (i)  hemiplegia,  (2)  incomplete  hemiplegia, 
(3)  hemianaesthesia,  (4)  hemianopsia,  (5)  deafness,  (6)  hemichorea,  hemiathetosis, 
tremor,  (7)  permanent  and  temporary  symptoms 


1 56 


156 


(h)   Localisation  within  the  nucleus  caudatus  and  nucleus  lenticularis :   (i)   no  local  symp- 
toms, (2)  indirect  hemiplegia,  (3)  elevation  of  temperature,  (4)  motor  disturbances 


(i)  Localisation  within  the  optic  thalamus :  (1)  no  local  symptoms,  (2)  indirect  hemiplegia 
or  hemianaesthesia,  (3)  hemianopsia,  (4)  motor  disturbances,  (5)  mimic  disturbances, 
(6)   vaso-motor  disturbances 


157 


158 


(/)    Localisation  within  the  corpora  quadrig-emina :    (i)    pupil    reaction,    (2)    oculo-motor 
paralysis.  (3)  ataxia.  (4)  tremor,  (5)  deafness 


(k)  Localisation  within  the  cerebellum  and  its  peduncles:  (i)  no  local  symptoms,  (2) 
cerebellar  ataxia,  (3)  vertigo,  (4)  vomiting,  (5)  tremor  and  nystagmus,  (6)  indirect 
hemiplegia,  (7)  retraction  of  neck 


160 


(/)   Localisation  within  the  brain  stem  considered  in  volume  one 


(  m  )   Localisation  at  the  base  of  the  brain  ( tum<  irs  i  : 

(a)   Tumors  of  the  pituitary  body:   (i)    acromegaly,    (2)    amblyopia,    (3)    bitemporal 
hemianopsia,  (4)  opthalmoplegia  and    exophthalmos,     (5)     diabetes    insipidus    and 

mellitus 


161 


( b )   Tumors  of  the  sella  turcica :  ( I )  same  as  in  "  a"  except  no  acromegaly 


(c)    Tumors   in   anterior   fossa    of   the  skull:    (i)    anosmia,    (2)    amblyopia,    (3)    oph- 
thalmoplegia,   (4)    sensory   disturbances  in  forehead,   (5)   motor  aphasia 


162 


(d)   Tumors  in  middle  fossa  of  the  skull:   (i  i   trigeminal  irritation  and  paralysis,   (2) 
ophthalmoplegia 


Tumors  in  posterior  fossa  of  the  skull:  (1  )  paralysis  of  the  5th  to  the  12th  cranial 
nerves.  (2)  pressure  on  medulla  (hemiplegia  or  paraplegia).  >sure  on  cere- 

bellum (verti 


LECTURE  XIX. 

Diseases  of  the   Brain 

FUNCTIONAL  DISEASES 

NEURASTHENIA 
Introductory 


Etiology:  (i)  race  (Semetic),  (2)  sex,  (3)  age,  (4)  heredity,  (5)  occupation,  (6)  excesses 
(alcoholic,  narcotics,  venery,  overwork),  (7)  emotions  (fright,  jealousy,  misfortune),  (8) 
mental  strain  (worry),  (9)  toxines,  (10)  chronic  local  disease  (ocular,  nasal,  pelvic),  (11) 
anaemia 


164 


16-5 


Pathological  anatomy:     (i)  negative 


166 


Symptomatology 

(a)   General:   (i)   weakness  and  irritability,  (2)  lack  of  endurance,  (3)  insomnia,  (4)  sens- 
ory disturbances,    (5)    motor  disturbances 


167 


168 


(b)   Psychic:    (i)    depression,    (2)    irritability.    (31    anxiety.    (4)    mental   inertia,    (5)    com- 
pulsory ideas.   (6)  pressure  in  head,  hallucinations,  delusions 


170 


(c)   Alimentary:   (I)   anorexia,   (2)   constipation,  (3)  diarrhoea,  (4)  dyspepsia,  flatulent  and 
hyperacidity 


(d)   Circulatory  and  secretory:  (1)   rapid  and  irregular  pulse,  (2)  palpitation,  (3)  flushing, 
(4)  sweating,  (5)  urine 


171 


(e)    Sexual:   (i)   masturbation,   (2)   emissions,  (3)  obscene  thoughts,  (4)  fear  of  impotency 


(/)   Combined  forms 


172 


Pathology:    (i)  lack  of  nerve  force,  (2)  lack  of  endurance,  (3)   weakness,  (4)  irritability 


Prognosis  and  course 


178 


Treatment:     (i)  rest,  (2)  food,  (3)  change  of  conditions,    (4)    massage  and  electricity,    (5) 
systematic  exercise,  (6)  tonics 


Hi 


175 


176 


LECTURE  XX. 

Diseases  of  the   Brain 

FUNCTIONAL  DISEASES    (Continued) 


HYSTERIA 
Introductory 


17' 


Etiology:  (i)  race  (Semetic  and  Latin),  (2)  climate,  (3)  civilization  and  cultivation,  (4) 
age,  (5)  sex,  (6)  heredity,  (7)  education,  (8)  example,  (9)  psychic  traumata,  acute  (emo- 
tions) or  chronic  (worry),  or  sexual  (rape,  jealousy,  masturbation,  etc.),  (10)  exhaustion 
and  anaemia,  (11)  local  disease,  (12)  menstruation,  (13)  excesses  (alcoholic,  narcotic, 
venery) 


178 


179 


Pathological  anatomy  :     ( i )  negative 


180 


Symptomatology 

(a)   General:   (i)  variability,   (2)   simulation  of  other  diseases,  (3)  fraud  and  feigning,  (4) 
chronic  general  condition  and  acute  or  chronic  local  or  general  attack 


161 


(b)  Psychic:  (i)  normal,  (2)  energetic  and  capable,  (3)  bright  and  attractive,  (4)  neur- 
asthenic, (5)  self-centered,  (6)  emotional,  theatrical  and  desirous  of  admiration,  (7) 
childish  liars,  (8)  suggestible,  (9)  irritable  and  lacking  in  self-control,  but  obstinate, 
(10)  insanity,  (11)  double  consciousness 


182 


184 


(c)   Sensory  disturbances  in  hysteria:   (  ii    manifold  and  multiple.  (2)  acuteness  of  percep- 
tion.  (3)  paraesthesiae,   (4)  hyperaesmesia    (ovarian,    spinal,    photophobia,    etc.). 
neuralgia   (ciavus,  etc.),   (6)   anaesthesia  (not  limited  to  distribution  of  any  nerve,  hemi- 
anaesthesia),  (7)  transference.  (8)  concentric  limitation  of  field  of  vision,  (9)  blindness, 
(ioj  deafness,  (11)  anosmia  and  ageusia 


186 


187 


(</)    Motor  disturbances  in  hysteria:   (i)   tremor,    (2)    lively    reflexes,    (3)    paralysis,    (4) 
astasia  and  abasia,   (5)   contracture,   (6)   convulsion 


188 


189 


(e)    Vaso-motor   and    secretory    disturbances:  (i)  flushing,  (2)  sweating,  (3)  erythema,  etc. 


190 


LECTURE  XXI. 

Diseases  of  the  Brain 

FUNCTIONAL  DISEASES   (Continued) 

HYSTERIA  (Continued) 
Symptomatology  (concluded; 

(f)  Lesser  or  local  hysterical  attacks :  (i)  nature  of  hysterical  attack,  (2)  many  symptoms 
described  under  the  chronic  stage,  as  paralysis,  contracture,  etc.,  may  occur  temporarily' 
as  acute  attacks,  (3)  laughing  or  crying,  (4)  aphonia,  (5)  globus  hystericus,  (6)  spas- 
modic stricture  of  oesophagus,  (7)  torticollis  and  other  spasms,  (8)  hysterical  cough, 
(9)  hiccough,  yawning  and  sneezing,  (10)  dyspnoea,  (11)  palpitation,  (12)  vomiting, 
( 13 )  regurgitation,  (14)  anorexia  and  fasting.  (15)  spinal  irritation,  (16)  tympanites, 
phantom  tumor  and  false  pregnancy,  (17)  peritonitis,  (18)  anuria  and  polyuria,  (19) 
melanuria,   (20)   hemorrhage,   (21)   fever 


r.M 


192 


194 


196 


(g)   Greater  or  general  hysterical  attacks :  (i)  convulsion,  (2)  catalepsy,  (3)  trance  (burial 
alive),   (4)  ecstasy,   (5)   somnambulism,   (6)   coma  ( narco-lethargy),   (7)   insanity 


I-: 


LECTURE  XXII. 
Diseases  of  the   Brain 

FUNCTIONAL  DISEASES    (Continued) 

HYSTERIA  (Continued) 

(h)  Hypnotism  and  suggestion:  (i)  method  of  production  (fascination  and  suggestion), 
(2)  result  obtained  (perversion  of  consciousness,  abeyance  of  volition,  imperative 
obedience,  analgesia,  etc.),  (3)  cataleptic  state  (eyes  open,  emotions  excited  by  gesture), 
(4)  lethargic  state  (eyes  closed,  neuro-myotatic  irritability),  (5)  somnambulistic  state 
(execution  of  commands),    (6)   telepathy,   (7)   suggestion  therapeutics 


200 


202 


204 


(i)   Clinical  subdivision  of  hysteria 


C  i  t   Convulsive  tic  and  local  spasm 


(2)   Paramyoclonus  multiplex 


(3)  Habit  chorea 


206 


(4)   Rhythmical  chorea 


(5)   Chorea  major 


207 


Pathology:    (i)   perverted  ambition,   (2)  psychosis  with  imperative  ideas,   (3)   exaggeration  of 
slight  symptoms 


208 


20!) 


LECTURE  XXIII. 

Diseases  of  the  Brain 

FUNCTIONAL  DISEASES    (Continued) 
HYSTERIA    (Concluded) 
Diagnosis:    (i)    multiplicity   and   variability   of  symptoms,   (2)   symptoms  inexplicable  bv  any 
organic  disease,  (3)  age  and  sex,  (4)  surroundings   (stage  setting),   (5)   globus  hystericus, 
(6)  emotional  nature,  (7)  ovarian  pressure,    (8)    deception.     (9)    Important  to   remember 
that  hysteria  may  accompany  and  mask  an  organic  disease. 


210 


Differential  diagnosis 

(a)   From  neurasthenia:  (i)  no  hysterical  attack,  (2)  no  simulation  of  organic  disease 


(b)   From  hypochondriasis:   (1)  no  hysterical  attack,  (2)  no  sensory  nor  motor  symptoms 


(c)    From  insanity 


21] 


(d)  From  epilepsy :  (i)  no  true  loss  of  consciousness,    (2)    effect  of  suggestion,    (3)    biting 
of  tongue  and  injuries,   (5)   duration  of  attack,  (4-)  ovarian  pressure 


(<?)   From  joint  disease:  (1)  etherization 


(/)   From  organic  paralysis  and  contractures 


212 


Prognosis  and  course 


Treatment 

(a)  Prophylactic:  (i)  healthy  environment,  (2)  separation  from  hysterical  and  nervous 
people,  (3)  wise  training,  (4)  out-of-door  athletics,  (5)  avoidance  of  excitement  and 
contests,   (6)  avoidance  of  all  excess 


213 


(b)  Of  chronic  hysterical  state:  (i)  physician  should  exercise  mental  influence  and  sugges- 
tion, (2)  encouragement  and  assurance  of  cure,  (3)  no  joking,  familiarity  nor  scolding, 
(4)  rest  and  isolation,  (5)  massage  and  electricity,  (6)  systematic  work  and  diversion, 
(7)  avoidance  of  worry  and  anxiety,  (8)  travel,  (9)  drugs  (valerian,  assafoetida,  phos- 
phates, malt,  iron,  arsenic,  bromides,  etc.) 


214 


21 


216 


(c)   Of  hysterical  attack:   fi)  mental  suggestion   and   encouragement, 

adic,  static  and  electric  brush),  (3)  blisters,    (4)    actual   cautery.    (5)    etherization. 
ovarian  or  supra-orbital  pressure,  171  cocaine,   (8)  quinine  in  lar. 
and  assafoetida.   (10)   bromides 


217 


218 


219 


LECTURE  XXIV. 

Diseases  of  the   Brain 

FUNCTIONAL  DISEASES    (Continued) 

CONVULSIVE  DISORDERS 


EPILEPSY 
Introductory:     (i)    symptomatic   and    idiopathic 


Etiology:  (i)  age,  (2)  sex,  (3)  heredity,  (4)  consanguinity  in  parents,  (5)  habitation,  (6) 
injurv.  (7)  infection,  (8)  poison,  (9)  sunstroke,  (10)  masturbation,  (11)  fright,  (12) 
reflex 


220 


221 


Pathological  anatomy:     (i)  negative  or  not  characteristic,   (2)   deformities  of  skull,   (3)   sec- 
ondary changes  in  brain 


222 


Symptomatology 

(a)  Of  major  epileptic  attack  (le  grand  mal)  :  (i)  aura,  (2)  sudden  onset,  (3)  uncon- 
sciousness, (4)  convulsion,  tonic  then  clonic.  (5)  secondary  symptoms,  (6)  duration, 
(7)  coma  or  semi-coma.  (8)  amnesia.  (9)  post-epileptic  insanity,  (10)  time  and  fre- 
quency of  attacks 


224 


(b)  Of  minor  epileptic  attack  (le  petit  mal)  :  (i)  aura.  (2)  sudden  onset,  (3)  unconsci 
ness,   (4)   pallor,   (5)  tendency  to  action.  (6)  amnesia 


(c)   Of  the  psychic  equivalent :  (i)  dream-like   state    (somnambulism),    (2)    insane    (mani- 
acal) 


226 


(d)  Of  epileptic  insanity :  (i)  transient  (post-epileptic  and  psychic  equivalent),   (2)   chronic 
(dementia) 


( c  )    Of  the  epileptic  state 


(/)  Of  the  epileptic  interval :  (i)  normal,  (2)  mental  weakness.   (3)   dementia 


228 


Pathology:    (i)   vaso-motor  theory,    (2)   cortical  irritation  theory 


Diagnosis:     (i)    unconsciousness,    (2)    amnesia 


Differential  diagnosis 

(a)   From  syncope:   (1)  no  convulsions,   (2)   cardiac  inadequacy 


(b)   From  Jacksonian  epilepsy:  (1)  localised  spasm 


(c)   From  uraemia:    (1)   long  duration,   (2)  albumen  and  casts 


(d)   From  hysteria:   (1)   unconsciousness  only  apparent,    (2)    duration,    (3)    suggestibility, 
(4)  stage  setting,  (5)  ovarian  pressure 


230 


(e)   From  organic  brain  disease:   (i)   other  cerebral  symptoms 


Prognosis  and  course 


Treatment:     (i)   remove  all  causes  of  irritation,  (2)  avoid  alcohol  and  tobacco,  (3)  trephining, 
(4)  drugs  (bromides,  nitrite  of  amyl,  hyoscyamine,  chloral  hydrate) 


LECTURE  XXV. 
Diseases  of  the  Brain 
FUNCTIONAL  DISEASES   (Continued)     [ 
CONVULSIVE  DISORDERS  (Continued) 

INFECTIVE  OR   SYDENHAM'S   CHOREA 
Introductory 


Etiology:  (i)  age,  (2)  sex,  (3)  heredity,  (4)  season,  (5)  anaemia,  (6)  nerve  strain  and 
school  work,  (7)  irritation  (ocular,  genital,  etc.),  (8)  fright,  (9)  infection,  (10)  rheumatism 
and  endocarditis,  (11)  pregnancy 


234 


Pathological   anatomy:     (i)   negative  in  nervous  system,  (2)  endocarditis 


Symptomatology:  (1)  sub-acute  onset,  (2)  characteristic  movements,  (3)  extent  (hemi- 
chorea),  (4)  effect  on  voluntary  movements  (speech,  deglutition,  walking,  etc.),  (5)  motor 
weakness,  (6)  psychic  symptoms.   (7)  cardiac  sounds,  (8)  duration 


236 


Pathology:    (i)  embolic  theory,  (2)  infection,  (3)  secondary  symptoms 


Diagnosis 


238 


Differential  diagnosis 

(a)   From  convulsive  tic 


( b  )    From  rhythmic  chorea 


(  c  i    From  habit  chorea 


Prognosis  and  course 


Treatment  :     (i)  rest,  (2)  drugs  (arsenic  and  chloral) 


DEGENERATIVE,  OR  HUNTINGTON'S  CHOREA 
Introductory 


Etiology:    (i)  age,  (2)  sex,  (3)  heredity 


Pathological  anatomy  :     ( 1 )  many  lesions,  but  none  characteristic 


240 


Symptomatology:     (i)    chronic  movements,    (2)   chronic  course.   (3)   steady  mental  deteri 
tion 


241 


Diagnosis 


Prognosis  and  course 


Treatment 


242 


TETANY 
Introductory 


Etiology:  (i)  age,  (2)  sex,  (3)  heredity,  (4)  season,  (5)  locality,  (6)  occupation,  (7)  auto- 
intoxication (digestive  disorders),  (8)  toxic,  (9)  infections,  (10)  rickets,  (11)  pregnancy. 
(12)   thyroid  extirpation,    (13;    complicating  other  nervous  disorders 


!43 


244 


Pathological  anatomy:     (i)   no  characteristic  I  2)  changes  in  central  spinal  gray  matter 

in  children 


Symptomatology:     (1)    characteristic  muscular  spasm.   (2)  muscles  attacked,   (3)  duration  of 
spasm.   (4)  Trousseau's  phenomenon.   (5)  increased  irritability  of  nerves,  (6)  insanity 


246 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment 


LECTURE  XXVI. 

Diseases  of  the  Brain 

FUNCTIONAL  DISEASES    (Continued) 

CONVULSIVE  DISORDERS  (Concluded) 


TETANUS 

Introductory 


Etiology:     (i)  age,   (2)  sex,  (3)  bacillus  of  tetanus,   (4)  tetanin,   (5)  wound,   (6)  puerperal, 
(7)   neonatorum.  _(8)   locality,   (9)   idiopathic 


248 


Pathological  anatomy:     (i)   changes  in  mot  inute  hen 


Symptomatology:    (i)  incubati 

and  temperature 


Pathology 


250 


Diagnosis 


Prognosis  and  course 


Treatment:     (i)  cauterization,  (2)  excision,  (3)  antitoxine,  (4)  drugs 


HYDROPHOBIA 

Introduction 


Etiology  :     ( i )  bite  of  an  animal,  especially  a  clog",  suffering-  from  rabies 


Pathological  anatomy 


252 


Symptomatology:     (i)    incubation,    (2)   prodromata,    (3)    tonic  spasm,  especially  of  pharynx, 
(4)  thirst 


Pathology 


Diagnosis 


Differential  diagnosis 

(a)   From  tetanus 


(&)   From  hysteria 


Prognosis  and  course 


Treatment:     (i)   cauterization,   (2)   Pasteur's 


254 


LOCAL  SPASMS 
Introduction 


Varieties  :    <  i  )  tonic,  (2)  clonic 


Etiology:     (1)  hysterical,  (2)  reflex,  (3)  neuritic  (rheumatic) 


Symptomatology:     (1)  may  attack  any  muscle,  (2)  more  commonly  occurring 


256 


Pathology 


Diagnosis 


Prognosis 


Treatment 


OCCUPATION  NEUROSES 
Introductory 


Varieties:    (i)   writers'  cramp,  telegraphists'  cramp,  (3)  pianists'  cramp.  (4)  violinists'  cramp, 

(  c\    QpanKtrps?'   rrntnn 


(5)  seamstress'  cramp 


Etiology:     (1)    neuropathic   predisposition,    (2)  exhaustion 


258 


Pathological  anatomy 


Symptomatology:     (i)  muscular  spasm,  (2)  pain 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment 


260 


TRAUMATIC   NEUR< 
Introductory 


Varieties:    (i)    neurasthenia,    (2)    hysteria.    131   tremor,   14)   chorea.   (5)   epilepsy 


Etiology:     <  1  1  psychic  trauma  acute  (injury  and   fright),   (2)   neuropathic  predisposition,   (3) 
exhaustion 


Pathological  anatomy 


Symptomatology:     (l)   depression,   (2)  neurasthenia,  (3)  neurosis,  (4)  tremor 


262 


Pathology 


Diagnosis  |  feigning) 


Prognosis  and  course 


Treatment 


LECTURE  XXVII. 
Diseases  of  the  Brain 
AUTO-INFECTION 
Introductory 


MYXOEDEMA    (CACHEXIA    STRUMIPRIVA)  AND  CRETINISM 
Introductory 


Etiology:     (i)   loss  of  function  of  thyroid,   (2)  age,  (3)  sex,  (4)  heredity 


264 


Pathological  anatomy 


Symptomatology 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment :     ( I )   thyroid 


266 


EXOPHTHALMIC  GOITRE 
Introductory 


Etiology:     (i)  excessive  function  of  thyroid,  (2)  age,  (3)  sex,  (4)  heredity,  (5)  psychic  trau- 
mata acute  and  chronic 


Pathological  anatomy 


267 


Symptomatology:     (i)  exophthalmus,  (2)  goitre.    (3)    rapid  pulse,    (4)    tremor,    (5)    Graefe's 
symptom,    (6)    vaso-motor  disturbances,    (7)  nervousness,  (8)  weakness,  (9)  emaciation 


268 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment:     i  i  i   rest,   (2)   drugs   (quinine  and  iron} 


ACROMEGALY 
Introductory 


Etiology:     (i)  hypertrophy  of  pituitary,  (2)  age,  (3)  sex 


Pathological   anatomy:      (1)   disease  of  pituitary  body  (tumor) 


Symptomatology:     (1)  enlargement  of  hands,  feet,   lower  jaw,   sternum,   etc.,    (2)    kyphosis, 
(3)  visual  symptoms,   (4)   glycosuria 


270 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment 


•J  71 


URAEMIA 

Introductory 


Etiology  :     ( i )  nephritis 


Pathological  anatomy  :     (i)    anaemia  of   brain,  (2)  oedema  of  brain 


Symptomatology:     (1)    coma,    (2)    convulsions,    (3)    restlessness,    (4)    headache,    (5)    vertigo, 
(6)  amaurosis,  (7)  hemiplegia 


272 


Pathology:    (]  |  urea,  (2)  toxic,  (3)  oedema  ami    an  (4)     atl  and 

irregular  blood  supply 


Diagnosis:     (i)  albumen  and  casts  in  urine,  (2)  other  cerebral  diseases  excluded 


Prognosis  and  course 


Treatment:     (1)  posture,  (2)  diaphoretics,  (3)  diuretics,  (4)  etherization 


274 


DIABETIC  COMA 


275 


PTOMAINE   AND   LEUCOMAINE  POISONING 


276 


LECTURE  XXVIII. 

Diseases  of  the   Brain 

TOXIC 


Introductory 


ALCOHOLIC  POISON  I X*  J 
(a)   Acute   alcoholism:    (i)    exaltation,    (2)  coma  or  semi-coma,  (3)  mania 


(b)   Sub  acute  alcoholism  :  in  delirium  tremens,    (2)    insanity    (maniacal  and  confusional) 


(c)   Chronic  alcoholism:    (i)    dementia,    (2)  insanity  (confusional  and  amnesic) 


278 


(d )   Treatment 


279 


NARCOTIC  POISONING 
Varieties:    (i)   opium,   (2)   chloral,   (3)   cocaine,  (4)  chloroform.  (5)  cannabis  in dica 


(a)   Acute  narcotism :  (1)  coma 


(b)   Chronic  narcotism:  (1)  nervousness,  (2)  neuralgia,  (3)  mental  weakness,  (4)  loss  of 
moral  sense,   (5)  insomnia,   (6)  tremor 


280 


(c)  Treatment 


281 


NICOTINE  POISONING 
(a)  Acute:   (i)  syncope,  (2)  vomiting,  (3)  coma  and  convulsions 


(b)   Chronic:    (1)    tremor,    (2)    intermittent  and  irregular  pulse,   (3)  palpitation  and  dysp- 
noea 


(c)  Treatment 


282 


BELLADONNA  POISONING 

(a)   Symptoms:    (i)   dryness  of  fauces,    (2)   dilated  pupils,  (3)  vertigo  and  headache,   (4) 
hallucinations,  (5)  erythenia 


(b)   Treatment:   (1)   morphine.   (2)   pilocarpine 


STRYCHNINE  POISONING 

(a)   Symptoms:   (1)   convulsions.   (2)   exaggeration  of  reflexes,   (3)   trismus.    (4)   opisthot- 
onos 


1 /' 1   Treatment:  (1)  emetics,  (2)  stomach  pump,  (3)  tannin.  (4)  morphine,  15)  chloral 


LEAD   POISONING 

(a)  Symptoms:  (i)  neuralgia  (colic  and  arthralgia),  (2)  paralysis  (extensor),  (3)  cerebral 
symptoms   (convulsions,  coma,  delirium,  headache) 


Treatment:     (1)     morphine,     (2)     heat,   (3)   iodide  of  potassium 


284 


286 


Introductory 


LECTURE  XXIX. 

Diseases  of  the  Brain 

TREMOR  AND  VERTIGO 

TREMOR 


Varieties 

(a)  Intention  tremor:  (i)  multiple  sclerosis,   (2)  general  paresis,   (3)   exophthalmic  goitre 

(b)  Passive  tremor:  (1)  paralysis  agitans,  (2)  hysterical  and  neurasthenic,  (3)  emotional, 
(4)  toxic,  (5)  senile,  (6)  weakness 


287 


VERTIGO 
Introductory- 


Experimental  vertigo  :  (i)  galvanism,  (2)  rapid  whirling  or  turning  of  body,  (3)  meningeal 
irritation,  (4)  injury  to  semi-circular  canals,  (5)  injury  to  cerebellum  or  its  peduncles,  (6) 
injury  to  sensory  nerves,  (7)  poison 


MENINGEAL  IRRITATION 


AURA  OF  EPILEPSY 


290 


MENIERE'S  DISEASE  ( AURAL  VERTIGO) 
Introductory 


Etiology:     (i)  age,   (2)  sex,   (3;  heredity,   (4)  injury,  (5)  disease  of  inner  ear,  (6)  rheuma- 
tism, (7)  syphilis 


Pathological  anatomy  :      (1)    lesions   of  semi-circular  canals,  (2)  lesion  of  inner  ear 


291 


Symptomatology:     (i)  vertigo,  (2)  tinnitus  aurium,  (3)  deafness,  (4)  vomiting,  (5)  falls,  (6) 
unconsciousness,    (7)   eye  symptoms,    (8)   headache,   (9)  ataxia,   (10)   duration 


292 


Pathology 


Diagnosis 


Prognosis  and  course 


Treatment 


293 


INJURY  TO  SEMI-CIRCULAR  CANALS 


CEREBELLAR    INJURIES    OR  DISEASES  (Direct  or  Indirect) 
(a)   Lesions:    (i)   tumors,    (2)   hemorrhages  and  softenings,  (3)  multiple  sclerosis 


(b)   Symptoms 


294 


DISEASES   OR   INJURY  OF   SENSORY    ORGANS    OR   NERVES 
(a)   Lesions  of  (i)  eye,  (2)  nerves  of  muscle  sense 


( b )   Symptoms 


FUNCTIONAL  NERVOUS  DISEASES 


TOXIC  VERTIGO 


2lJG 


LECTURE  XXX. 
Diseases  of  the  Brain 

HEADACHE 

Introductory 


Location  of  headache  indicative  of  its  origin 


Varieties 

(a)   Neuralgic:   (i)   supra-orbital,   (2)   occipital 


(/'i    Muscular  rheumatism:  1  1  1  scalp  muscl  talis) 


•j'.  •: 


(c)   Symptomatic  of  visceral  disease:  (i)  pelvic,   (2)  gastric 


(d)   Symptomatic  of  organic  brain  disease :   (1)    meningitis,    (2)    syphilis,    (3)    tumor    and 
abscess 


(e)  Toxic:  (1)  fever  (infection),  (2)  uraemic,  (3)  constipation,  (4)  alcoholic  and  narcotic, 
(5)  lead,  etc. 


298 


(/)   Nerve  strain:  (i)  neurasthenic  and  hysterical,   (2)   mental  exhaustion,   (3)   eye  strain, 
(4)  pelvic  irritation 


299 


(g)   Vascular:   (i)   anaemic,    (2)   congestive  (nitroglycerine,  nitrite  of  amyl),  (3)  migraine 


MIGRAINE 

Etiology:     (1)   age,   (2)   sex,   (3)   heredity,   (4)   infection,    (5)    exciting"  cause   (excesses,  alco- 
holic or  sexual,  menstruation,  worry,  emotions,  indigestion) 


:'>00 


Pathological  anatomy 


Symptomatology:  (I)  paroxysmal  attacks,  (2)  premonitory  symptoms,  (3)  aura,  (4)  head- 
ache (hemicrania),  (5)  hyperalgesia,  (6)  vaso-motor  and  secretory  disturbances,  (7)  nausea 
and  vomiting,  (8)  duration,  (9)  imperfect  attacks,  (10)  the  hemicranial  equivalent 


SOI 


o02 


Pathology  :    ( i )  vaso-motor  spasm  or  paralysis 


Diagnosis 


Prognosis  and  course 


Treatment 


304 


LECTURE  XXXI. 
Diseases  of  the   Brain 

GEXERAL  REVIEW  AND  SUMMARY 
Introductory 


Diseases  to  be  considered 


General  etiology 

(A)   Primary  Factors 

(a)   Direct  heredity  and  congenital  defects:    (]  I    mainly   organic   disi  '     cranial 

abnormalities  and  encephalocele,  (3)  meningitis,  tubercular  and  syphilitic,  14) 
cerebral  palsy  of  childhood,  (5)  cerebral  hemorrhage,  (6)  tumor,  171  convulsive 
disorders  (epilepsy,  chorea,  infective  and  degenerative),  (8)  neurasthenia  1  ?)  and 
hysteria  1  ?  I 


(b)   Indirect  heredity   (neuropathic  predisposition):  (i)  all  the  functional  diseases,  (2) 
no  organic  diseases  except  degenerative  chorea 


(c)   Infections:  (1)  acute  meningitis,  (2)    syphilis,    (3)    tetanus  and  hydrophobia,    (4) 
infective  chorea,  (5)  abscess 


306 


( </ )    Intoxications:    (i)    chronic   meningitis,  (2)  alcoholism.  (3)  drugs 


(e)   Auto-intoxications:    (1)    myxoedema,   (2)   exophthalmic  goitre.   (3)  uraemia.   (4) 
diabetic  coma,  (5)  ptomaine  or  leucomaine  pois<  ning 


1 /' 1   Traumatism:   (1)   concussion,  compression    and    contusion.     (2)     meningil 
hemorrhage,    (4)    cerebral  palsy  of  childhood,  (5)  epilepsy,  (6)  tumor,  171  ab 


Extension   of   inflammation:    id  meningitis,  (2)  abs< 


307 


(Ji)   Other  diseases:   (i)   diseases  of  blood  vessels,   (2)   diseases  of  thyroid,   (3)  tuber- 
culosis,   (4)    tumors,    extension   or  metastasis,  (5)  nephritis,  (6)  diabetes 


(B)   Secondary  Factors 

(a)  Age:  (1)  childhood  (hydrocephalus,  cerebral  palsy  of  childhood,  meningitis, 
chorea,  tetany),  (2)  adult  age  (syphilis,  neurasthenia,  hysteria,  (3)  old  age 
(apoplexy) 


(b)   Sex:   (1)   female   (hysteria),   (2)   male  (injuries,  syphilis) 


308 


(c)   Race  (hysteria  in  the  Semetic  and  Latin  races) 


(d)   Season  (chorea) 


(  e  )   Cold  and  dampness 


(/)    Psychic  traumata  acute   (emotions)  or  chronic  (worry) 


(  £  )    Kx  cesses 


(In   Combination  of  etiological  factors 


General  pathological  anatomy 

(A)  Organic  Diseases 

(a)    Nervous  tissue  not  primarily  involved  in  most  cerebral  diseases 


(b)  Diseases  of  the  membranes:   (i)  congenital  abnormalities,   (2)   meningitis 


(c)  Diseases  of  the  blood  vessels:   (1)   fatty   degeneration,    endarteritis,   miliary   aneu- 
risms,  (2)  rupture,   (3)  occlusion,  (4)   sinus  thrombosis,   (5)   abscess 


310 


id)   Disease-  of  the  neuroglia:   (i)   thickening  of  fil  itwork  and  increase  of  cells, 

(2)  sclerosis.   (3)   glioma,   (4)  abscess 


0)   Changes   in  the  nerve  elements    (neurons),    mi    degeneration    of  the   nerve   cell 

1  homogeneous  swelling-,  granular,  sclerotic  and  hyaline  degenerati  vacuoles 

in  cells,  (3)  calcification  of  cells,  (4)    degeneration  of  nerve  fibre-  secondary 
degeneration 


311 


(B)  Functional  Diseases 
(a)  Congenitally  weak 


(b)  Irritative  (reflex) 


(c)  Blood  supply 


(d)  Chemical  or  toxic 


312 


General  symptomatology 


(A)  General  Diminution  of  Cerebral  Activity  (due  to  destructive  lesion  >  : 

(a)  Loss  of  consciousness :  (i)  coma.  (2)  semi-coma  or  stupor,  (3)  sopor,  14)  somno- 
lence, (5)  confusion  or  giddiness,  (6)  drowsiness  (traumatic  compression,  etc., 
apoplexy,  epilepsy,  sinus  thrombosis,  meningitis,  tumor,  general  paresis,  multiple 
sclerosis,  alcoholism,  narcotism,  uraemia,  diabetes,  fever) 


(b)  Loss  of  intelligence :  (i)  amentia  (idiocy,  imbecility,  feeble  minded),   (2)   dementia 
(result  of  insanity  and  of  the  diseases  noted  above  under  "a") 


(c)  Loss  of  feeling  (emotions)  :   (1)  apathy  (neurasthenia  and  insanity) 


(d)    Loss  of  memory  in  general:    (1)  amnesia    (diffuse  atrophic  or  degenerative  cor- 
tical changes  usually  of  vascular  origin ) 


314 


(B)   Partial  Diminution  of  Cerebral  Activity  (due  to  focal  lesion)  : 

(a)    Loss  of  vision:    d)    limitation  of  field  of  vision  for  white  and  colors   (hysteria), 
homonymous  hemianopsia  (apoplexy,  tumor),   (3)  blindness  (meningitis,  apo- 
plexy, tumor,   uraemia).    (4)    psychic  blindness   (meningitis,  tumor,  apoplexy) 


315 


(b)   Loss  of  speech:   (i)   motor  aphasia,  (2)  sensory  aphasia,  (3)  transcortical  aphasia 
(tumor,  apoplexy,  meningitis ) 


316 


(c)   Loss  of  reading  and  writing:   (i)   alexia,   (2)   agraphia   (tumor,  apoplexy,  menin- 
gitis) 


i  d )   Loss  of  smell  and  taste:   (i)   anosmia.   (2)  ageusia   (tumor,  apoplexy,  meningitis) 


( (■  i  Loss  of  cutaneous  and  muscular  sensibilit)  :  (1)  astereogn  bemjanaesthesia, 

(3)  hemianalgesia,  (4)  thermic  hemianaesthesia,    (5)    loss  of  muscle  sense    (apo- 
plexy, tumor,  meningitis,  hysteria) 


31' 


(/)   Monoplegia   (apoplexy,  tumor,  meningitis,  hysteria) 


(g)  Hemiplegia,  total  or  partial   (apoplexy,  tumor,  meningitis,  hysteria,  uraemia) 


318 


(h)  Cerebral  diplegia  (cerebral  palsy  of  childhood,  double  hemorrhage,  tumor,  hysteria) 


(t)   Crossed  hemiplegia,  dysphasia,  dysphagia,  Cheyne-Stokes  respiration,  temporal  and 
nasal  hemianopsia,  etc.,  have  been  discussed  in  volume  one 


319 


(C)  Exaggeration  of  Cerebral  Activity: 

(a)   Psychic:   (i)   insomnia   (neurasthenia) 


(b)  Sensory:  (i)  hyperesthesia,  (2)  hyperalgesia,  (3)  thermic  hyperesthesia,  (4) 
hyperosmia,  (5)  hypergeusia,  (6)  photophobia,  (7)  intolerance  to  sound  (all  may 
occur  in  hysteria) 


"20 


(c)  Motor:  (i)  contracture,  active  or  passive    (meningitis,   apoplexy,   cerebral   pals; 
childhood,  tetany,  hysteria),  (2)  restlessness  (neurasthenia  and  hysteria),  (3)  con- 
vulsion, general,  unilateral  or  monospasm  :  tonic,  clonic,  tetanic,  choreiform    (  epil- 
epsy, tetanus,  hydrophobia,  hysteria,  chorea,  meningitis,  apoplexy,  cerebral  palsy  of 
childhood,  tumor  j 


(D)  Perversion  of  Cerebral  Activity: 

(a)  Psychic:  (i)  depressed  and  apprehensive  (insanity,  traumatic  neuroses,  neuras- 
thenia, hysteria,  chronic  narcotism),  (2)  joyous  and  exalted  (insanity,  hysteria), 
(3)  changeable  (insanity,  hysteria  chronic  narcotism),  (4)  hallucinations,  (5) 
delusions,  (6)  delirium  (last  three  may  occur  in  fever,  insanity,  chronic  nar- 
cotism, meningitis) 


322 


(b)   Sensory:   (i)  headache,   (2)  peripheral  pain,   (3)   paraesthesiae,   (4)   vertigo,   (5) 
vomiting-  (all  may  occur  in  meningitis,  tumor,  syphilis,  neurasthenia,  hysteria) 


Motor:  (i)  cortical  ataxia  (tumor,  apoplexy,  or  meningitis  of  cerebral  cortex, 
causing  astereognosis),  (2)  cerebellar  ataxia  (lesions  of  cerebellum  or  its  pe- 
duncles, (3)  tremor  (neurasthenia,  hysteria,  exophthalmic  goitre,  multiple  sclerosis, 
post-hemiplegic),  (4)  athetosis  (post-hemiplegic),  (5)  inertia  (hysteria  or  cat- 
alepsy) 


324 


General  pathology 

(a)   Result  of  increased  pressure:   (i)   general,  (2)  local 


(b)  Result  of  anaemia:  (1)  general,  (2)  local 


1  c  1   Result  of  irregular  blood  supply 


(d)   Result  of  cortical  irritation:    (i)   general,  (2)  local 


(e)  Result  of  poisons 


(/)  Result  of  lack  of  nerve  force 


326 


Diagnosis  :  (ij  psychic  disturbances,  (2)  unilateral  distribution  of  the  paralyses,  (3)  convul- 
sions and  other  irritative  symptoms,  (4)  absence  of  degenerative  muscular  atrophy,  (5) 
local  symptoms 


Prognosis  and  course 


Treatment 

(a)   General  prophylaxis:    (i)   direct  inheritance,    (2)   neuropathic  predisposition,    (3)    con- 
sanguinious  marriages,    (4)    education,  (5)   manner  of  life,   (6)   food  and  stimulants 


328 


(b)  The  actual  disease:  (i)  rest,  (2)  systematic  exercise,  (3)  massage,  (4)  electricity,  (5) 
hydrotherapeutics,  (6)  heat  and  cold,  (7)  drugs  (hypnotics,  sedatives,  nerve  tonics, 
circulatory) 


330 


332 


APPENDIX 


INSANITY 
Introductory 


334 


336 


Method  of  examination 

(a)  A  complete  history  and  physical  examination  made  according  to  the  scheme   given   in 
volume  one  is  necessary  in  every  case 


(b)  Points  to  be  especially  observed :  (i)  subjective    symptoms    (history)    are   much    more 
important  than  the  objective   (physical  examination),    (2)    obtain   all   the   information 
possible  before  seeing  the  patient,  (3)  ascertain  the  degree  of  culture,  peculiarities  and 
temperament  of  the  patient  previous  to  the  attack.  (4)  do  not  deceive  the  patient. 
note  time  of  mental  reaction 


General  etiology 

(a)   Predisposing  causes:   (i)   age,   (2)   sex,  (3)  heredity  (direct  inheritance,  neurasthenic 
predisposition,  consanguineous  marriages) 


338 


(b)  Exciting  causes:  (i)  acute  psychical  traumata  (emotions),  (2)  chronic  psychical  trau- 
mata (worry  and  grief;,  (3)  alcoholism  and  narcotism,  (4)  infection  (syphilis),  (5) 
physical  traumata,  (6)  organic  and  functional  brain  diseases,  (7)  visceral  diseases, 
(pelvic,  thyroid,  etc.) 


340 


Pathological  anatomy:     (i)   the  brain,   (2)   the  blood  v  3)  the  lympathics,  (4)  the  pia- 

arachnoid,  (5)  the  dura  mater,  (6)  the  skull 


:.ii 


342 


General  symptomatology 

(A)   Prodromal  or  Neurasthenic  Stage:   (i)  insomnia,   (2)   weakness,  fatigue,  morning 
tire,   (3)  irritability  or  languor,  (4)  weakened  attention,  (5)  mental  depression 


:;i  I 


(B)  Stage  of  Active  Insanity: 

(a)   Intellect  (the  patient's  reasoning-)  :  (i)   sense  perception    (hallucinations,  illusions), 

(2)  memory,  recent  and  remote  (arithmetical  problems,  dates,  ages,  names,  etc.), 

(3)  thought,  flow  of  ideas  (retarded,  accelerated,  incoherent),   (4)   judgment   (de- 
lusions, imperative  ideas) 


341 


345 


(b)  Feelings  (the  patient's  mood):  (i)  depressed  (fear,  grief,  remorse),  (2)  excited 
(irritability,  turbulence,  confusion),  (3)  enfeebled  (indifference,  apathy),  (4) 
changeable 


546 


(c)  Actions:  (i)  conduct  (quiet,  dull,  agitated,  violent,  indecent),  (2)  habits  and  tend- 
encies (destructive,  dirty,  untidy,  dangerous,  homicidal,  suicidal,  criminal),  (3) 
speech  (mute,  taciturn,  voluble,  disconnected,  incoherent,  thick,  unintelligible,  scan- 
ning), (4)  handwriting 


34* 


348 


(d)   Consciousness:    (i)   of  self,   (2)   of  others  and  of  surroundings,  (3)  delirium,  coma, 
semi-coma,  convulsions 


Special  Symptomatology 

(A)    Functional  Insanity 


(a)  Idiopathic: 


*  Psychoses 


(i)  melancholia 


{simple 
delusional 


fwith  agitation 
(with  stupor 


350 


("simple 
(2)   mania  •{  delusional 


acute  delirious 


.;  ,1 


(3)   confusional  insanity 


352 


(4 )   primary  dementia 


f  Psychic  degenerations 


354 


(i)   recurrent,  periodic  and  circular  insanity 


(2)   chronic  delusional  insanity    (paranoia) 


356 


(b)   Symptomatic 


(  i  )   epileptic  insanity 


(2)   hysterical  insanity 


(3)  neurasthenic  insanity 


358 


(c)  Terminal  dementia 


(B)  Organic  Insanity 


(  i  )   general  paresis 


360 


senile  insanity 

(2)   insanity  of  arterio-sclerosis  ..     . 

lie  insanity 


362 


(3)  insanity  with  gross  organic  disease  of  the  brain  (cerebral  syphilis,  tumor,  apoplexy, 
etc.) 


(C)   Mental  Disorders  or  Defects  not  Considered  as  Insanity: 

(i)   idiocy,  (2)  imbecility,  (3)  crime,   (4)   alcoholism,    (5)    delirium 


364 


Diagnosis  :    (i)  the  determination  of  insanity,  (2)  feigned  insanity 


366 


Differential  diagnosis  of  the  forms  of  insanity 


307 


Prognosis    and    course  :      (i)   of  the  acute  psychoses,    (2)    of  psychic   degenerations,    (3)    of 
organic  insanity 


Treatment:     (i)   mental  or  moral,   (2)   physical,    (3)    hydrotherapeutics,    (4)    drugs,    (5)    at 
home,  (G)  general  hospital,  (j)  in  special  hospital  (asylum) 


370 


EXAMINATION  OF  THE  BLOOD. 
Introductory 


Technic  of  obtaining  the  blood 


Technic  of  haemoglobin  test  :    (i)    Tallquist.   (2)  Cowers,  (3)  Fleischl,  (4)  Dare 


371 


372 


Significance   of    haemoglobin    percentage:     (a)      Increased      i  plethora;,      (b)     Diminished 
(chlorosis,    leukaemia,    pseudoleukemia,    and  all  forms  of  anaemia) 


percentage  of  haemoglobin  1 ( l( ' 

Color  Index  =  =  _  =  100# 

percentage  of  red  corpuscles         5,000,000 

(a)   Increased  (pernicious  anaemia,  (b)  diminished  (chlorosis  and  most  forms  of  anaemia) 


Technic  of  estimating  the  specific  gravity  of  the  blood  :     (i)    Hammerschlag's  Method,   (2) 
Schmalz 


Significance  of  the  specific  gravity  of  the  blood  :     (a)  Varies  with  the  haemoglobin 

SP.  GR.     HAEMOGL.      SP.  GR.   HAEMOGL.  SP.  GR.     HAEMOGL.      SP.  GR.    HAEMOGL. 

1030  20$  1042.5        45$  105 1  65$  1057-5        90$ 

1035  30$  1045-5        5o$  J052  7o?<  !059  100$ 

1038  35$  1048  55$  1053.5        75$ 

1 04 1  40$  1049  60$  1056  80$ 

(b)   Increased  relatively  to  the  Haemoglobin  (leukaemia),    (c)    relatively  diminished    (per- 
nicious anaemia) 


Technic  of  ascertaining  the  number  of  red  corpuscles  :    (1)  Thoma-Zeiss,   (2)   Haematokrit, 
(3)  Haemocytometer 


374 


Significance  of  the  number  of  red  corpuscles 

I  Increase  or  polycythaemia  [(i)  after  recovery  from  anaemia,  (2)  after  transfusion,  (3) 
after  profuse  diarrhoea,  sweating  or  vomiting,  (4)  high  altitudes,  (5)  phosphorous 
poisoning] 


376 


(b)   Decrease  or  anaemia,  primary   (pernicious)   or  secondary    [(i)   after  hemorrha 

malaria,  (3)  acute  septicaemia,  14;  toxic  intestinal  parasites,  chlorate  of  potash 

poisoning,  etc.),  (5)  anaemias  of  early  childhi  rms  of  all  anaemias] 


Technic  of  ascertaining  the  number  of  white  corpuscles  :    (1  )  Zappert-Thoma-! 


Significance  of  the  number  of  white  cells 

(a)  Diminution  or  leucopenia  [always  (i)  starvation,  sometimes  (2)  measles,  (3)  grippe, 
(4)  tuberculosis,  uncomplicated,  (5)  malaria,  (6)  typhoid,  often  (7)  pernicious  and 
severe  secondary  anaemias,   (8)   splenic  anaemia] 


378 


(b)  Increase  or  leucocytosis  [physiological  (i)  new-born  (24000),  (2)  digestion  (12000). 
(31  pregnancy  (13000  to  18000),  (4)  exercise  and  baths  (12000).  pathological  (5) 
post-hemorrhagic  (16000  to  18000),  (6)  moribund,  inflammatory  (j)  cholera,  (8) 
relapsing  fever,  (9)  typhus,  (10)  scarletina,  (11)  diphtheria,  (12)  tonsilitis,  (13)  sec- 
ondary syphilis,  (14)  erysipelas,  (15)  bubonic  plague,  (16)  yellow  fever,  (17)  pneu- 
monia. (18)  small-pox,  (19)  pyaemia  and  septicaemia,  (20)  actinomycosis,  (21)  trichi- 
nosis, (22)  anthrax,  (23;  acute  multiple  neuritis,  (24)  acute  articular  rheumatism,  (25) 
meningitis,  non-tubercular,  (26)  cholecystitis.  (2?)  acute  pancreatitis,  (28)  gonorrhoea, 
(29)  abscess,  (30)  pyelo-nephritis,  (31)  appendicitis.  (32;  phlebitis,  (33)  osteomyelitis, 
(34)  salpingitis.  (35)  peritonitis,  (36)  pericarditis,  (37)  pleuritis.  (38)  empyema,  (39) 
gangrene,  toxic  (40)  illuminating  gas,  (41)  quinine,  (42)  rickets,  (43)  gout,  (44) 
yellow  atrophy  of  the  liver,  (45)  advanced  hepatic  cirrhosis,  (46)  acute  gastroenter- 
itis, (47 J  uraemia,  (48)  after  injections  of  tuberculin,  thyroid  and  normal  salt  solutions, 
(49)  malignant  disease,  (50)  drugs  (vegetable  tonics,  essential  oils,  pilocarpine  potas- 
sium chlorate,  chloroform  and  ether  inhalations,  salicylates,  phenacetin  and  antipyrine] 


380 


Technic  of  examination  of  fresh  specimen  of  blood 


Information  derived  from  examination  of  fresh  blood  :  (i)  plasmodium  malariae,  (2)  spi- 
rochaete  of  relapsing  fever,  (3)  filaria  sanguinis  hominis,  (4)  anthrax  and  other  bacteria, 
i  5  )  amount  of  fibrin,  (6)  approximate  ratio  of  white  and  red  corpuscles,  (7)  approximate 
ratio  of  different  varieties  of  white  corpuscles,  (8)  deformities  of  red  corpuscles,  (9)  amount 
of  blood  plates 


Technic  of  making  a  smear  of  blood  :    (i)  cover  glass,  (2)  slides,  (3)  fixing,  (4)  staining 
(Ehrlick,  Jenner,  Goldham),  (5)   differential  counting 


382 


. 


Information  obtained  from  examination  of  blood  smear 

(a)  Red  corpuscles :  (i)  normal,  (2)  endoglobular  changes,  (3)  crenation  and  poikilocytosis, 
(4)  oval,  (5)  staining  reaction,  (6)  nucleated  (normoblasts,  megaloblasts,  micro- 
blasts),    (7)   granular  degeneration,    (8)  plasmodium  malariae 


EXAMINATION   OF  THE  BLOOD. 


.'"'••:%X 
r.-o  #5 


r     •     %•         tV 


Fig.   i.     VARIETIES   OF    LEUCOCYTES  —  Stained  by  Jenners   Method,     i,    Small    lymphocyte; 

2,  Intermediate  between  small  and  large  lymphocyte:  3,  Large  lymphocyte;  4,  Myelocyte:  5.  Degenerat- 
ed  polymorphonuclear;    6,    Polymorphonuclear;    6',    Polymorphonuclear   containing    a    bacillus;    :. 
Polymorphonuclear  with  Nei  sser  granules;  S,  Eosinophile  myelocyte;  o.  Eosinophile:  10.  M:ist  cell. 


o 


% 


O 


Fig    2.     VARIETIES   OF    RED   CELLS—  Stained  with  Eosin  and  Methylf.ni  Blui       i,  Normal; 
2,    Deficient   in    Haemoglobin;   3,    Microcyte;   4,    Poikilocyte;   5.    Vacuolated;    6,    Megalocyte; 
7.  Polyehromatophilic ;  8,  Microblast;  9,  Megaloblast;  u>.  Normoblast:  11,  Division  form;    12,    Punctate 
erythrocyte;  13,  Blood  plates. 


0  O   Q   ® 


OO© 


e 


a 


10 


The  Tertian  Form  01  Malarial  Pa*a 
Figures  1  t..  7  represent  thi  development  »l  a  Haematotoon  within  the  substanci  ol  a  redbloodcell 
■1  to  10  represent  the  d  idult  form  into  ni  w  parasites      In  figure   10  there  is  reprt 

II  and  the  young  parasites  are  fret  to  enter  other  blood  cells 


(b)  White  corpuscles:  (i)  normal  (small  lymphocytes  20 — 30'/'.   large   lymphocytes,  4 

polymorphonuclear  neutrophile  leucocytes  62 — 70^,  eosinophle  leucocytes  [-2 — 4  .mast- 
cells  [leucocytes]  1-40 — l-'2#),  (2)  leucocytosis,  (3)  lympho  inophilia, 
( 5  i  myelocites 


386 


Technic  of  agglutination  test,  serum  reaction  (WidaPs  test) 


as; 


388 


EXAMINATION    OF    SPUTUM 
Introductory 


Method  of  obtaining  sputum  in  infants 


Macroscopic  examination 

(a)  Quantity:  (i)  swallowed  in  children  and  some  adults  (women),  (2)  scanty  (bronchitis, 
incipient  tuberculosis,  whooping  cough,  laryngitis  asthma),  (3)  abundant  (empyema, 
perforating,  advanced  tuberculosis,  chronic  bronchitis  and  bronchiectasis,  oedema) 


( l> )    Reaction:   (alkaline) 


1  <■  i  Odor:  (1)  gangrene,  (2)  abscess,  (3)  cavities 


(d)   Sedimentation  in   layers:    (i)    cavities,   (2)   chronic  bronchitis  and  bronchiectasis,   (3) 
gangrene 


(e)  Character  of  sputum:  (1)  watery  or  serous  (oedema),  (2)  viscid  or  mucuous  (pneu- 
monia, influenza,  bronchitis,  tuberculosis,  whooping  cough),  (3)  muco-purulent 
(chronic  bronchitis,  tuberculosis,  pneumonia,  resolving),  (4)  purulent  (cavities,  empy- 
ema), (5)  nummular  (tuberculosis,  chronic  bronchitis),  (6)  rusty  (pneumonia),  (7) 
prune  juice  and  currant  jelly  (pneumonia,  cancer),  (8)  frothy  (oedema,  broncho-pneu- 
monia, bronchitis),  (9)  hemorrhagic  (tuberculosis,  oedema,  infarction,  aneurism,  purpura, 
hysteria),  (10)  black  (inhaled  dust),  (11)  yellow  or  green  (hepatic  abscess,  perforat- 
ing), (12)  bronchial  casts   (fibrinous  or  croupous  bronchitis) 


390 


Microscopic  examination 

(a)   Selection  of  specimen :  (i)  inspection,  (2)  boiling  with  alkali,  (3)  centrifuging 


( /' )   Technic  of  examination  of  fresh  specimen 


(c)  Results  of  examination  of  fresh  specimen:  (i)  epithelium,  (2)  pus  cells  (empyema, 
tuberculosis,  chronic  bronchitis  and  bronchiectasis),  (3)  eosinophylic  cells  (asthma), 
(4)  Charcot-Leyden's  crystals  (asthma),  (5)  Curschmann's  spirals  (asthma),  (6) 
elastic  fibres  (gangrene,  cavities),  (7)  hematoidin  crystals  (old  hemorrhage,  tuberculosis, 
cardiac  disease),   (8)   Echinococcus  hooklets,  (9)  actinomycoces 


392 


(d)   Technic  of  examination  of  dried  specimen:  (i)  smear,  (2)  fixing  (heat).  (3)  staining 
(Koch,  Ziehl-Xeelsen.   Gabbett,  Loemer,  Gram),  (4)  microscope 


(e)  Results  of  examination  of  dried  specimen:  (i)  tubercle  bacillus,  (2)  Fraenkel's  pneu- 
mococcus,  (3)  Friedlaender's  pneumococcus,  (4)  influenza  bacillus,  (5)  streptococcus 
and  staphylococcus,  (6)  aspergillus,  (7)  actinomycosis 


394 


EXAMINATION   OF  THE  URIXE 
Introductory 


Physical  characters 

(a)  Quantity:  (i)  normal  and  physiological  variations,  (2)  increased  or  polyuria  (diabetes 
mellitus,  diabetes  insipidus,  chronic  interstitial  nephritis,  amyloid  nephritis,  elimination 
of  large  effusions,  angina  pectoris,  hysteria,  tumors  of  brain  stem),  (3)  diminished  or 
oliguria   (parenchymatous  nephritis,  cardiac  disease,  fever,  diarrhoea,  hysteria) 


(b)  Specific  gravity :  (i)  normal  and  physiological  variations,  (2)  varies  in  the  quantity 
secreted,  (3)  a  measure  of  the  solids  excreted  by  the  kidneys,  (4)  large  amount  of  urine 
with  high  specific  gravity  (diabetes  mellitus),  (5)  small  amount  of  urine  with  low  spe- 
cific gravity    (uraemia  threatening) 


(c)   Transparency  and  sediment:   (1)   normal,   (2 )   urates,    (3)   phosphates,   (4)   mucus  and 
pus,  (5)  bacteria,  (6)  shreds 


(d)  Color:  (1)  normal  and  physiological  variations,  (2)  pale  (polyuria),  (3)  dark  (oli- 
guria), (4)  red,  reddish-brown,  smoky  (haematuria),  (5)  greenish-brown  or  greenish- 
black  (choluria),  (6)  black  (alkapturia,  carbolic  acid,  salicylic  acid,  santonin,  naph- 
tholin,  etc.),    (7)   milky    ( chyluria ) ,    (8)   blue   (indigo,  methylene  blue) 


896 


(e)  Odor:    (i)    normal.    (2)    ammoniacal,   (31  eliminating  odors. 


(/)  Reaction:  (1)  normal  and  physiological  variations,  (2)  increased  acidity  (fever, 
gout  [?]),  (3)  ammonia  alkalinity  (decomposition,  urethritis,  cystitis),  (4)  fixed  alkali 
alkalinity   (vomiting  and  gastric  disease,   food,  anaemia,  neurasthenia) 


Normal  chemical  constituents 

Urea:  1  I  1  quantitative  tests  (Squibb,  Doremus,  from  sp.  gr. ).  (2)  normal  amount  and 
physiological  variations,  (3)  renal  adequacy.  (4)  increased  (febrile  diseases,  diabetes, 
blood  diseases,  poisoning  by  phosphorus  and  arsenic),  (5)  diminished  (nephritis,  hepatic 

diseases,  many  chronic  diseases) 


897 


(b)  Uric  acid:  (i)  quantitative  tests  (Haycraft  Heintz),  (2)  normal  amount  and  physio- 
logical variations,  (3)  increased  (acute  fevers,  leukaemia,  gout  and  rheumatism,  food), 
(4)    diminished    (diabetes,  anaemia,  chronic  interstital  nephritis) 


(c)   Salts:  (1)  chlorides,  (2)  phosphates,  (3)  sulphates 


Abnormal  chemical  constituents 

(a)  Albumen:  (1)  qualitative  tests  (nitric  acid,  heat  and  nitric  acid,  Trichloracetic  test),  (2) 
quantitative  test  (Esbach),  (3)  albuminuria  (all  forms  of  nephritis,  primary  or  second- 
ary, cystitis,  urethritis,  infectious  fevers,  haemic  diseases,  cardiac  and  pulmonary  dis- 
eases, drugs,  high  arterial  tension) 


398 


(b)   Albumose:   (i)  tests   (heat),   (2)   albumosuria   (infectious  fevers,  suppuration,  myelo- 
mata, osteomalacia) 


(c)  Sugar:  (1)  qualitative  test  (Fehlings,  Haines,  Nylander  fermentation),  (2)  quantitative 
test  (Fehling,  fermentation,  Einhorn's  saccharometer),  (3)  glycosuria  (excessive  sac- 
charine and  starchy  food  with  sedentary  life  and  nerve  strain,  diabetes  mellitus),  infect- 
ious  fevers  during  convalescence,   injury  to  nervous  system 


(d)  Acetone:  (i)  tests  (Gunning),  (2)  acetonuria  (fever,  hunger,  meat  diet,  diabetes  mell- 
itus  digestive  disturbances,  carcinoma) 


(e)  Di-acetic  acid:  (1)  tests  (Gerhardt),  (2)  diaceturia  (diabetes  mellitus,  fever,  dyspeptic 
disturbances,   autointoxication   in   drinkers) 


(/)  Blood:  (1)  tests  (spectroscope,  Schoenbein-Almen),  (2)  Haematuria  and  Haemoglobi- 
nuria  (inflammations,  tumors  or  injuries  of  any  part  of  urinary  tract,  haemic  diseases, 
purpura,  infectious  diseases) 


400 


(g)   Haematin:    (i)    tests    (barium  chloride  and  -  [aematoporphyrinuria 

i  -ul tonal  and  trional  poisoning  i 


(In   Indican:  (i)  tests  (Jaffe),  (2)  indicanuria  (deficiency  of  hydrochloric  acid  in  stomach, 

intestinal    disorders,    especially    obstruction  or  sluggish  action,  pu 


Bile  pigments:   (1)   tests   (Gmelin),   (2)    Icteric  urine   (when  bile  pigments  are  in  the 

blood) 


(;')    Diazoreaction   (Ehrlich)    (typhoid,  acute  miliary  tuberculi  re  and  rapid  pulmo- 

nary tuberculosis,  measles,  etc.) 


401 


Microscopic  examination  of  the  urine 

(a)   Method  of  collecting  sediment:   (i)   sedimentation,  (2)  centrifuging,  (3)  both 


(b)   Urates:   (1)  appearance,  (2)  significance  (acid,  concentrated  urine,  fevers) 


(c)  Uric  acid:   (1)  appearance,   (2)  significance   (acid,  concentrated  urine,  gout,  rheuma- 
tism, fever) 


(d)   Calcic   oxalate:    (1)    appearance,    (2)   significance  (food,  dyspepsia) 


{e)   Phosphates  amorphous:  (1)  appearance,  (2)  significance  (alkaline,  decomposing  urine) 


402 


(f)   Fat:  (i)  appearance,  (2)  significance  (phosphorous    poisoning,    obesity,    fat    embolism, 
chyluria) 


(g)   Epithelial  cells:  (1)  appearance,  (2)  significance  (inflammations  of  urinary  tract) 


(h)   Pus  cells:   (1)   appearance,   (2)   significance  (inflammations  of  urinary  tract) 


(»)   Red  blood  cells:  (i)  appearance,  (2)  significance  (hemorrhage  of  urinary  tract) 


103 


(/)    Epithelial  casts:   (i)  appearance,   (2)  significance  (renal  inflammation  or  degeneration) 


(k)   Granular  casts :  (i)  appearance,  (2)  significance   (renal  inflammation  or  degeneration) 


(/)   Hyaline  casts :   (1)  appearance,   (2)   significance  (renal  inflammation  or  degeneration) 


(m)    Fatty  casts:  (1)  appearance,  (2)  significance  (renal  inflammation  or  degeneration) 


(«)   Waxy  casts:  (1)  appearance,  (2)  significance  (renal  inflammation  or  degeneration) 


404 


URINARY  SEDIMENT. 


Epithelial  Cells,   a,    felvic;    b,    Vaginal . 
c,   Bladder. 


Fig.    2.     a,    Pus    cells;      b,    Pus    cells    treated    with 
acetic    acid ;    c,    Gonorrheal    thread ; 
d,  Spermatozoa;  e,  Corpora  Amylacea. 


Foreign  Substances    a.  Linen  fibre ; 

b,  Cotton  fibre;    c.    Air  bubbles:    d.    Wool 

fibre ;  e,  Scale  of  moths  wing. 


Fig.   4      Rarer   Crystals     a,  Cyst  in;     b,   Leucin; 
c,    Tyrusin;     d,    Calcium     Phos| 

Calcium  Carbonate. 


Fig.   5.     Acid    1'kine.    a,  Calcium  Oxalate ;    b,  Uri 

nil    of    lira 

d,   Colorless  Uric  Acid. 


Fig.  ft.     Alkalini    Urine,     a,     Triple    phosphate 
b,  Ammonium  urati 


Fig,   7      Casts     ...    Hyalim      b,    H 

fine   granules;   < .    Mn.  uus   ihn 
d,  Cylindi 


I 
d,  Free  blood  cells 


(a)    Blood,  pus  and  bacterial  casts:   (i)   appearance.  (2)  significance 


( />  )   Cylindroids  of  unknown  origin  and   significance 


(q)    Parasites    (1)    filaria  sanguinis  hominis,  (2)  echinococcus 


Bacteria:   (1)   typhoid,   (2)  tubercle,   (3)  gonococcus,  (4)  coli  communis,  (5)  staphyl- 
ococcus and  streptococcus 


106 


EXAMINATION  OF  STOMACH  CONTENTS 
Introductory- 


Vomited  matter:      (i)  quantity,  (2)  odor,  (3)  reaction 


(A)   Contains  remnants  of  food  (time  and  character  of  preceding  meals) 

(1)  Food    completely    digested    (vomiting  nervous,  reflex,  cerebral,  spinal,  beginning  of 
gastric  ulcer  or  catarrh) 

(2)  Food  partly  digested  (mucus  present-gastritis) 

(3)  Food  not  at  all  digested  (atrophy  —  if  there  have  been  several  hours  between  the 
taking  of  food  and  the  vomiting) 


40G 


(B)  Abnormal  substances: 

(i)   Blood:  Bright  red  to  coffee-ground  appearance   (ulcer,  carcinoma,  hepatic  cirrho- 
sis, gastric  stases  in  circulatory  disorders.     Exclude  non-gastric  causes) 


(2)   Pus:    (Gastritis    phlegmonosa,    ulcerating  carcinoma.     It  may  come  from  bronchi, 
pharynx,  posterior  nares) 


(3)   Mucus:  In  small  quantities  always   present.     In   large  quantities   gastric  catarrh, 
chronic  pharyngeal  catarrh,  morning  vomiting) 


■107 


(4)  Bile :  Often  found  in  vomitus  and  seldom  has  a  special  significance  (acute  gas- 
tritis, peritonitis,  gastro-intestinal  disorders,  reflexly  in  diseases  of  the  liver,  kidneys, 
ovaries,   uterus   and   in   tabes   dorsalis) 


( 5 )   Fasces 


(6)   Parasites :    (Ascarides,  taeniae,  oxyures,  vermiculares,  anchylostoma,  trichinae) 


(7)  Tissue  particles  (mucous  membrane,  tumors) 


408 


Gastric  contents  after  test  meals 

(i)   Test  breakfast  of  Ewald-Boas 


(2)   Test  meal  of  Riegel 


(A  )   Appearance 

(1)    Undigested,  (2)  partially  digested,  (3)  completely  digested 


(4)    Presence  of  abnormal  elements:  (a)    blood,    (b)    mucus,    (c)    bile,    (d)    relation  of 
solids  to  liquids  —  3  layers,  mucus,  liquid,  chyme 


(/•')   Quantity  (20-50  c.  1.)  (a)  diminished   (hypermotility,    gastric    neuroses,    chronic 
tritis,  incontinence  of  pylorus)    (fc)   increased  (motor  insufficienc 


(C)   Odor   (markedly  sour,  stale,  sweetish) 


Chemical  examination 

( i )   Reaction 


(2)   Presence  of  free  acids  (congo  red,  Tropaeolin  tests) 


(3)  Test  for  free  hydrochloric  acid  (Phloroglucin,  vanilla,  Resorcin,  dimethyl,  amido  azo- 
benzol ) 


410 


(4)   Determination  of  total  acidity  (Phenolphathalein  and   i-io  normal  solution  of  caustic 
soda) 


(5)  Test^for  free  lactic  acid  (Uffelman's) 


Determination  of  butyric  and  acetic  acids 


171    Examination  for  pepsin  and  Rennin  fe 


■in 


Microscopical  examination 

(i)   Chyme:  (a)  starches,  (b)  meat,  ( c)  fats 


(2)    Abnormal  elements:  Epithelial  cells,  red    and    white,    blood    cells,    sarcinae    yeast   cells, 
crystals,  bacteria,  tissue  particles 


Determination  of  gastric  motility 

(a)    Test  meals:  (i)  Leube  test  meal,  (2)  test  breakfast 
(  b  )    Salad  test :    ( 1 )    Huber  modification 


412 


Gastric  insufficiency  due  to 

( i )   Weakness  of  contracting'  muscles 

(2)   Obstruction  to  the  contracting  muscles 

I  1  I    Gastric  myasthenia : 

(a)  Congenital  condition   (rare) 

(b)  Following  constitutional   diseases   (anaemia,  chlorosis,  phthisis  pulmonalis,  chronic 
malaria,    amyloid   degeneration,    syphilis,  typhoid  fever,  nervous  affections) 

(2)    (a)   Obstructions  in  the  stomach  itself   (ulcer,  carcinoma  of  pylorus,  polypus) 

(b)  Obstructions  due  to  conditions  outside  of  the  stomach  (tumors,  adhesions,  contract- 
ures, floating  kidney,  herniae  ) 


ii:; 


Diagnostic  significance  of  the  gastric  tests 

( i )   Normal  acidity :  No  severe  textural  disease  of  stomach,  probably  a  neurosis.    May  also 
occur  with  gastric  atony 


(2)  Hyperacidity:  Gastric  neurosis,  ulcer,  a  benign  glandular  hypertrophy,  carcinoma  upon 
the  base  of  an  ulcer 

(3)  Anacidity:  Chronic  gastritis,  gastric  neurosis,  carcinoma 

(4)  Lactic  acid :  Occurs  with  stagnation  and  absence  of  hydrochloric  acid,  carcinoma 

(5)  Acetic  acid:  Result  of  alcoholic  fermentation  where  there  is  gastric  stagnation  advanced 
fermentation  of  carbohydrates 

(6)  Diminution  of  pepsin  and  Rennin:  Marked  diminution  indicates  a  permanent  injury  of 
the  gastric  glands 

(7)  Presence  of  yeast  cells  and  sarcinae:  They  occur  in  small  numbers  in  different  gastric- 
disease,  but  are  observed  in  large  numbers  only  in  excessive  stagnation 


414 


415 


EXAMINATION  OF  FiECES 
Introductory 


(i)   Quantity  (depends  on  food.       oz.  iv.-vii.) 


(2)   Color:  Usually  dark  brown   (light  yellow,  clay  colored,  green,  black  —  food,  drugs,  bile, 
blood) 


(3)   Consistency:    Soft    sausage-shaped    (ribbon- shaped,     scybala;     abnormally     mushy     or 
liquid) 


(4)   Odor :  Increased  by  retention  in  bowel  (sour,  offensive,  musty,  putrid) 


(5)  Reaction:  Neutral  or  slightly  alkaline  (vegetable   diet  slightly  acid,   occlusion  of  bile 
strongly  acid) 


416 


(6)   Undigested  food  (normally  small  particles   of  vegetable   substances.        Meat   indicates 
severe  intestinal  lesion.     Milk  curds) 


Abnormal  contents 

(i)  Blood:  Red,  dark  or  tarry  (portion  of  intestine,  state  of  peristalsis).  Most  frequent 
causes :  hemorrhoids,  typhoid  fever,  colitis,  cancer  of  colon.  Large  hemorrhages 
(typhoid  fever,  portal  engorgement,  haemophilia,  purpura,  aneurism).  Small  hemor- 
rhages   (hemorrhoids,    injury   to    rectum,  fissure,  ulceration,  intussusception  in  children) 


(2)  Mucus:  Glassy  layer  about  faeces,  membrane,  yellowish  in  color  and  well  mixed  with 
faeces,  small  particles  floating  in  watery  dejecta.  (Inflammation  of  large  or  small 
intestine,  dysentery  proctitis,  impaction  of  faeces) 


117 


(3)   Pus:  Large  quantity  (abscess,  pelvic  periproctitic  perinephritic).     Small  quantity  (dys- 
entery, enteritis,  proctitis,  ulceration  of  rectum  or  colon) 


(4)   Fatty  stools  (obstructive  jaundice,  disease  of  pancreas,   indigestion  or  overfeeding  in 
infants) 


(5)   Calculi:  (a)  gall  stones,  (b)  pancreatic  calculi,  (c)  enteroliths,   (d)  coproliths 


(6)   Foreign  bodies :     Coins,  marbles,  bones,  needles 


(7)   Parasites   (ascaris  lumbricoides,  oxyuris  vermicularis,  taenia  saginata,  taenia  solium) 


Microscopical  examination 

(1)   Remnants  of  food  (fat,  starches,  muscle  fibres) 


418 


(2)   Crystals  (Charcot-Leyden,  lime  crystals,  fatty  phosphates,  cholesterin,  haematoidin) 


(3)   Blood:   (Lower  intestine,  upper  intestine,  haematoidin  or  its  crystals) 


(4)   Pus:  (ulcerations,  abscess,  dysentery) 


(5)   Mucus:  (Catarrh  of  intestines,  membranous  enteritis) 


(6)   Parasites : 

(a)   Animal:   (1)   worms,    (2)   protozoa  (amoeba  coli) 


119 


(b)  Vegetable:   (i)   comma  bacillus,  bacillus  typhosis,  bacillus  coli  communis,  bacillus 
tuberculosis 


(7)  Ova  of  entozoa:  (1)  oxyuris  vermicularis.  (2)  ascaris  lumbricoides,  (3)  trichocephalus 
drspar,  (4)  taenia  solium,  (5)  taenia  medrocanellata,  (6)  Bothriocephalus  latus,  (7) 
Distoma  hepaticum,  (8)  Distoma  lanceolatum,  (9)  anchylostomum  duodenale 


420 


INDEX 


Abscess  of   the   brain,   112. 

Acetone  and  acetonuria,  400. 

Acid,  free  in  gastric  contents,  tests  for  and  signifi- 
cance  of,   410. 

Acrany.    9. 

Acromegaly,    161,    270. 

Ageusia,   185,  317. 

Agglutination   test,    387. 

Agraphia,   317;   localization,   151;   tests  for,   7. 

Albumen  in  urine,   tests  for,  398. 

Albuminuria,   significance  of,   398. 

Albumose  in   urine,   tests  for  and  significance  of,  399. 

Alcoholism,   88,   277,  278,   364. 

Alexia,  317;  localization,  146,  148;  tests  for,  7. 

Amblyopia,  151,   161,  162. 

Amentia,  014 ;   t    sts  for,  3. 

Amnesia,    314,    344;    epileptic,    223,    225;    tests   for,    3,    344. 

Anaemia   of   the   brain,    63. 

Anencephaly,  9. 

Aneurism   in  brain,   120;   miliary.    72. 

Anosmia,    317;    localization,   151,    153,    162;    tests   for,   7. 

Aphasia,  motor,  5,  151,  102,  316;  optic,  148;  sensory,  5, 
153,   316;    tests   for,   5;   transcortical,   5,    316. 

Apoplexy,  71;   differential  diagnosis  of,  87,  98. 

Arteritis   syphilitica,   131,   135. 
la,   abasia,   188. 
■  ■gnosis.  112,  146,  317. 

Ataxia,  cerebellar.  160,  324;  cerebral,  151,  159,  324. 

Athetosis,    324;    localization,    155. 

Auto-infection,  cerebral  diseases  due  to,  264. 

Belladonna    poisoning 

Blood,  color  Index,  373;  differential  count,  382;  exam- 
ination of,  371.  381;  fixing,  382;  haemoglobin  in,  371,  373; 
in  faeces,  417,  419;  in  urine,  400;  In  vomitus,  407;  red 
corpuscles  in,  374,  376,  377;  smear,  382;  specific  gravity 
of,  373;  staining,  382;  white  corpuscles  in,  377,  378, 
385. 
hycephaly,   9. 

Brain,  abscess  of,  112;  anaemia  of,  63;  hemorrhage  In, 
71;  hyperaemia  of,  67;  inflammation  of.  111;  injuries 
of,  47,  56;  oedema  of,  69;  softening  of,  93;  tumor  of, 
119. 

in    urine,    (04. 
lepsy,   197,   200, 

Cephalalgia 

Cerebellum,    localization    In,   160. 

Cerebral    absc  maemia,    63;    compression,    53; 

concussion,  47;  contusion,  56;  diplegia,  108;  embolism, 
93;  hemorrhage,  09;  hyperaemia,  67;  Injuries,  47,  56; 
localization,  Ml,  I'.l  ;  oedema,  69;  palsy  of  childhood, 
111;  inns  thrombosis,  100;  softening,  93;  syphilis, 
thrombosis,  93;  tumor,  119;  cerebral  diseases, 
diagnosis  of,  327;  rtlology  of,  305;  examination  of,  3; 
pathological  anatomy  of.  310;  pathology  of,  325;  prog- 
nosis of,  328;  symptomatology  of,  313;  treatment  of, 
328. 


Cerebro-spinal   syphilis,    134. 

Choked   disc,    114,    122. 
-teatoma,    120. 

Chorea,  degenerative,  240;  habit,  206;  Huntington's, 
240;  infective,  234;  major,  207;  minor,  234;  rhythmic, 
207;  Sydenham's,  234. 

Color  index  of  blood,  373. 

Coma,  313,  349;  apoplectic,  SO,  84;  diabetic,  275;  differ- 
ential diagnosis  of,  87;  epileptic,  223,  225;  hysterical, 
107;   tests   for,   3;    uraemic,    272. 

Compression  of  the  brain,  53. 

Concussion  of  the  brain,  47. 

Confusional  insanity,   352. 

Consciousness,   349;   tests  for,   3. 

Contracture,   18S,   321. 

Contusion  of  the  brain,  56. 

Convulsions,  114,  122,  188,  321,  349;  epileptic,  223;  hys- 
terical,  188,   197. 

Convulsive  disorders,   220,   234,  248. 

Convulsive   tic,  205. 

Corpora  quadrigemina,   localization   in,   159. 

Cranial  abnormalities,  9. 

Cretinism,   264. 

Crime.    364. 

Cyst   of   brain,    12". 

Delirium,  322,  364. 

Delusions,    322. 

Dementia,  3,  227,  228,  314,  353,  359. 

Di-acetic  acid  in  urine,  400. 

Diagnosis   of  brain  disease,   327;  of   insanity,   366. 

Diabetic    coma,    275. 

Diazoreaction,   401. 

Diplegia,    cerebral,    10S,    319. 

Dolycocephaly,    9. 

Ecstasy,   197. 

Embolism  of  the  brain,  93. 
Encephalitis,    111. 
Encephalocele,    9. 
Endarteritis   syphilitica,   131. 
Eosinophils  and  eosinophilia,   385. 
:>sy,    89,    220;   Jacksonlan,    142, 
Epileptic,    aura,    223,    225;    Insanity,    223,    226,    227,    357; 
Interval,    228;    major   attack,    223;    minor  attack,    225; 
.    228. 
Etiology  of  brain  disease,  305;  of  Insanity,  338. 
(nation  of  cases  of  cerebral  disease,  S. 
Mialmlc   goltn- 

Faeces,  abnormal  constituents,  417;  blood  in,  417.  418; 
calculi  In,  418;  examination  of,  416;  fat  in,  418;  micro- 
scopical examination  of,  418;  mucus  in,  417,  419; 
ova  In,  420;  parasites  In,  418,  419;  physical  characters 
of,   416;    pus   in,    118,    419. 

Fllaria  sanguinis  lmminis  in  blood,  381;  in  urine,  406. 
il    lobe,    localization   in,   151. 


421 


INDEX 


Gastric  contents  after  test  meals,  409;  bile  in,  408; 
blood  in,  407;  examination  of,  406;  faeces  in,  408; 
free  acids  in,  410;  hydrochloric  acid  in,  410;  lactic 
acid  in,  411;  microscopic  examination  of,  412;  motility 
of.  409,  412;  mucus  in,  407;  pus  in,  407;  total  acidity, 
411. 

General    paresis,    359. 

Glioma,    120. 

Glycosuria,   significance  of,   399. 

Goitre,   exophthalmic,  267. 

Gumma,  120;   structure  of,   130. 

Haematin    and    haematoporphyrinuria,    401. 
Haematoma  of  dura  mater,  12,  14. 
Haemoglobin   test,    371;   percentage,   373. 
Hallucinations,  322,  344;  auditory,  153;  odoriferous,   153; 

optic,    148. 
Headache,  297,  323. 
Hemiamblyopia,    148. 
Hemianaesthesia,   155,   185,   317. 
Hemianopsia,    315;    localization,    146,    148,    155,    157,  •161; 

tests    for,    5. 
Hemiathetosis,   155. 
Hemichorea,  155,   236. 
Hemichromatopsia,   148. 
Hemiplegia,   82,  106,   142,   155,   318. 
Hemorrhage,    cerebral,    71;    meningeal,    61. 
Hydrocephalus,    9,   29;    acute,    41;    chronic   external,    41; 

chronic  internal.   42. 
Hydrochloric  acid  in  gastric  contents,  410. 
Hydrophobia,  252. 
Hyperaesthesia,  320. 
Hyperaemia  of  the  brain,   65. 
Hypnotism,   200. 
Hysteria,  89,  177. 
Hysterical  insanity,  197,  358;  major  attacks,  197;  minor 

attacks,   191. 

Idiocy,   314,   364. 

Imbecility,   314,   364. 

Indican   and  indicanuria,   401. 

Inertia,  324. 

Inflammation  of  the  brain,  111. 

Injury  of  the  brain,  47,  56. 

Insanity,  334;  alcoholic,  277,  27S,  364;  circular,  355;  classi- 
fication of,  350;  confusional  352;  diagnosis  of,  366; 
epileptic  223,  226,  227,  357;  etiology  of,  338;  examination 
for,  337;  functional,  350;  hysterical,  197;  in  tetany, 
246;  neurasthenic,  358;  organic,  363;  pathology  of,  341; 
prognosis  of,  368;  senile,  361;  symptomatology  of, 
343,   350;   treatment  of,   369. 

Insomnia,   167,   280,   320,   343. 

Intelligence,  tests  for,  3. 

Internal   capsule,   localization   in,    155. 

Intracranial  tumor,  119. 

Jacksonian  epilepsy,  142. 
Kernig's   symptom,   23. 

Lactic   acid   in   gastric   contents,    411. 

Lead  poisoning,  284. 

Leptomeningitis,    10;    acute,    la;    chronic,    37. 

Leucocytes   and   leucocytosis,   377,   385. 

Leucopenia,   378. 

Localization,  141,  151;  at  base  of  brain,  161;  central 
white  substance,  155;  cerebellar,  160;  cerebral,  141; 
corpora  quadrigemina,  159;  frontal  lobe,  151;  internal 
capsule,  155;  nucleus  candatus,  157;  nucleus  lenticu- 
laris,  157;  occipital  lobe,  148;  optic  thalamus,  157; 
parietal  lobe,   146;    temporal   lobe,    153. 

Lumbar  puncture,   24,  27,  31,   35,   44. 

Lymphocytes    and    lymphocitosis,    385. 


Mania,   351. 

Melancholia,  350. 

Memory,   tests  for,   3. 

Meniere's    disease,    291. 

Meningeal  hemorrhage,    61;    irritation,   22,   30,   290. 

Meningitis,  10;  cerebro-spinal,  18;  chronic,  37;  gum- 
mosa, 130,  132;  purulent,  33;  serous,  36;  syphilitic,  130, 
132;   tubercular,  28. 

Mental   disorders,   3,   334. 

Microcephaly,  9. 

Migraine,  300. 

Miliary  aneurism,  72. 

Monoplegia,  318. 

Morphine   poisoning,    88,    2S0. 

Motor  centers,   localization  of,   142. 

Myelocytes,    385. 

Myoclonus  multiplex,   206. 

Myxoedema,    264. 

Narco-lethargy,  197,  200. 

Narcotism,    88,    280 

Neurasthenia,    164. 

Neurasthenic  insanity,  35S. 

Neuroses,   occupation,   258;   traumatic,   261. 

Nicotine  poisoning,  282. 

Nucleated   red   blood   corpuscles,   384'. 

Nucleus   caudatus,    localization   in,    157. 

Nucleus  lenticularis,   localization  in,   157. 

Nystagmus,  160. 

Occipital  lobe,   localization  in,  148. 
Occupation   neuroses,    258. 
Oedema,  cerebral,  69. 
Oliguria,    395. 

Ophthalmoplegia,  161,  162,  163. 

Optic,  aphasia,  148;  neuritis,  114,  122,  136;  thalamus, 
localization   in,   157. 

Pachymeningitis,  10;  externa,  10;  interna  haemor- 
rhagica,   12;   interna  purulenta,  12. 

Paramyoclonus    multiplex,    206. 

Paranoia,    355. 

Paresis,  359. 

Parietal  lobe,  localization  in,  146. 

Pathological  anatomy  of  cerebral  diseases,  310;  of 
insanity,    341. 

Pathology    of    cerebral   diseases,    327. 

Penetrating  wounds  of  the  brain,   59. 

Periarteritis  syphilitica,  131,  135. 

Perineuritis  syphilitica,   131,  136. 

Pituitary  body,  tumors  of,  161. 

Plasmodium    malariae   in    blood,    381,    384. 

Poikilocytosis,   381,   384. 

Poisoning,    277. 

Polyuria,  395. 

Porencephaly,    104. 

Post-syphilitic   nervous   diseases,    128. 

Prognosis    of   brain   diseases,    328;    of   insanity,    36S. 

Psamoma,   120. 

Ptomaine  poisoning,    276. 

Psychic  blindness,  5,  148,  315;  deafness,  153;  degenera- 
tions, 354;  depression,  322,  343,  346,  350;  disorders,  tests 
for,  3;  equivalent,  227;  exaltation,  322,  346;  variability, 
322,  346. 

Psychoses,  350. 

Red    blood    corpuscles,    374;    counting    of,    374;    diminu- 
tion of,   377;   increase  of,   376. 
Review,   305. 

Senile  insanity,   361. 
Sinus  thrombosis,   100. 
Softening  of  the  brain,  93. 
Somnambulism,   197,   200,   226. 
Spasms,    local,    255. 


422 


INDEX 


Speech,    disturbances    of,    5,    347. 

Spirochaete  of  relapsing  fever  in  blood,  381. 

Sputum,  examination  of,  389;  macroscopic,  3S9;  micro- 
scopic,  391. 

Stomach,   motility  of,   409,   412. 

Strychnine   poisoning-,   283. 

Sugar  in  the  urine,  399. 

Suggestion,  200. 

Summary,  305. 

Symptomatology  of  brain  disease,  313;  of  insanity, 
343,  350. 

Syphilis  of  the  nervous  system,   128,  134. 

Syphilitic,  arteritis,  131,  135:  endarteritis,  131;  menin- 
gitis, 130,  132;  neuritis,  131. 

Temporal    lobe,    localization    in,    153. 

Telepathy,    200. 

Test  breakfast  in  gastric  diagnosis,  409,   412. 

Test  meal  in  gastric  diagnosis,  409,  412. 

Tetanus,   248. 

Tetany,  243. 

Thrombosis,   cerebral,   93;   sinus,   100. 

Tic,   convulsive,   205. 

Toxic  cerebral   disease,   277. 

Trance,   197. 

Traumatic    neuroses,    261. 


Treatment  of  brain   diseases,   32S;   of  insanity,   369.' 
Tremor,  286,   324. 
Tumor,   intracranial,  119. 

Uraemia,    87,   272. 

Urea  in  urine,  397. 

Uric  acid  in  urine,  398,  402. 

Urine,  abnormal  constituents  of,  398;  bile  pigments, 
in,  401;  examination  of,  395;  microscopic  examination 
of,  402;  normal  constituents  of,  397;  physical  char- 
acters of,  395. 

Vertigo,    160,    288,    323;    aural,    291;    cerebellar,    160,    294; 

epileptic,     290;     experimental,     2S8;     hysterical. 

meningeal,   290;   neurasthenic,   295;   ocular,   295;   toxic 

296. 
"Vision,  tests  for  disturbances  of,  5. 
Vomiting,   160,   323,    406. 
Vomitus,    406;    bile    in,    408;    blood   in,    407;    examination 

of,    406;    faeces   in,    408;    microscopic    examination   of, 

412;  mucus  in,  407;  pus  in,  407. 

AVhite  blood  corpuscles,  377;  counting  of,  377;  decrease 

of,   378;   increase  of,   379. 
Widal's   test,   387. 
Writer's   cramp,   258. 


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